Wednesday, 1 April 2020

How to support people with long-term health conditions living in their own homes self-isolating

By John Evans OBE, disability rights, equalities and diversity consultant and trainer and SCIE trustee

This situation requires much vigilance and responsibility for PAs/Carers who support disabled people, as the virus could be life-threatening for these people. It is as important for the PAs themselves to maintain their good health at the same time. This blog is directed at people who are self-isolating and their PAs or carers who help to support them.
Coronavirus is present here in Hampshire and Portsmouth so keen awareness is required whilst it is increasing.
It is important to try and act in ways which can protect these people, particularly those self-isolating as well as yourself. The government is encouraging people with different health conditions and people over 70 to self-isolate and might in the end make that a formal obligation.
People need to be sure they have adequate supplies of protective clothing for their PAs and carers like gloves, gowns or aprons. It is now very difficult getting masks even though we are told they are not that effective.
Many experts have proposed how vital social distancing is in order to try and not come into close contact with others in the streets and especially supermarkets and pharmacies. This should apply to everything. The government today has discouraged people from any non-essential contact with others.
While the coronavirus is still rampant and increasing daily, it is best to do online shopping to avoid going into supermarkets. If it is required on the odd occasion, then one should specify to one’s support workers to choose quiet times to make visits to supermarkets when not many people are there. What is also worrying is that many supermarkets are running out of soap, gel, antibacterial wipes etc which are all vital to people with long-term health conditions in maintaining appropriate high standards of hygiene. I am a severely disabled person with respiratory difficulties and employ my own PAs. We are self-isolating along with my wife and do not allow anybody in to my house. Thankfully we have a community support group doing shopping as well as some friends so we are lucky particularly no with supermarkets not having delivery slots available.
Obviously stay well away from others who might be coughing or sneezing in the near vicinity.
Whenever returning to the disabled people’s homes always wash your hands thoroughly straight away. Wash them again after you have put the provisions away and throughout the day and night.
It is best to avoid outside contact as this is where the virus could be picked up, so be careful even when mixing with friends. Some people are more aware than others of the seriousness of the situation. I am hearing stories all the time about people who do not seem to be taking it seriously and are still mixing in groups!
This situation now requires much more rigid and robust hygienic actions in everything to restrict any possibility of bacteria and germs developing.
Experts have said it is important to clean the surfaces in the kitchen regularly every day as the virus can last for up to 18 hours. This should also apply to the bathroom, bedroom and living-room.
When receiving packages and mail from outside, one should also wash one’s hands after handling them. Apparently, I read that germs and bacteria can stay on cardboard for up to 24 hours! Provisions from supermarkets should also be cleaned and plastic bags thrown away.
It is also useful to regularly clean door and window handles, as well as light and electrical switches. When preparing food or doing anything else for the person self-isolating, it is crucial to always wash your hands.
Be sure to make any health professionals e.g. district nurses, GPs and others wash their hands if they make visits. I had to instruct the district nurse to wash her hands when she came in last week as she didn’t! I have found it very useful to have a polite notice placed on all entry doors asking people to wash their hands when entering into the home of the person at risk.
Visitors should also be made aware of carrying a fresh tissue with them at all times in case they have to sneeze or cough. Tissue boxes should always be available at all entry doors. However, if one is self-isolating then as hard as it is it is best not to have visitors at all. Hopefully the weather will get better soon so contact in one’s gardens could be possible.

Sunday, 29 March 2020

Sharing lives and self-isolating

By Alex Fox OBE, Chief Executive of Shared Lives Plus and Trustee at the Social Care Institute for Excellence 

This originally appeared on Alex's blog, which also has the latest news - and a link to a podcast from homesharers Norman and Jorge.

Across the UK, thousands of Shared Lives households are at home as self-isolation becomes mandatory. This means that disabled people, people with mental health problems and others who need significant support are living in a safe place with their Shared Lives carer and for many, this is the safest place they could be. Unlike other services which rely on a staff rota, no one need come in and out of the home and the household can be more resilient and less disrupted by self-isolation than services which lose workers who are self-isolating but currently unable to get tested.
We also know that Shared Lives households are under pressure:
  1. 80% of Shared Lives carers are over 50 and 20% are over 70 and themselves in the at-risk group.
  2. Usually, Shared Lives should not be 24/7 care, but at the moment it is: this can mean huge pressure on households as routines are disrupted and there is no break from caring for someone who is distressed and whose behaviour may be difficult to manage.
  3. Like others, Shared Lives households are largely without protective equipment (PPE) and facing shortages of basics and food caused by panic buying.
  4. As short breaks and day support services are cancelled, many self-employed Shared Lives carers are without income, and the government has not yet addressed this for the self-employed. This also means there are Shared Lives carers with capacity to do more and who want to help. We’ve had members wanting to open their homes to patients and NHS staff.
At Shared Lives Plus, our team moved quickly to 100% home working and online and have been working flat out on two priorities for our members: inform and connect. People need the right information – not always easy when most government info has been unclear, incomplete or has needed to be corrected. Not helped by government making a drastic u-turn in its strategy (which was the right thing to do: their modelling turned out to be wrong) but then telling people nothing had really changed: far better to have been clear that the strategy had changed and why. Connection will be of growing importance the longer this situation continues.
We are addressing the four pressure points above:
  1. We have issued guidance for local organisations on identifying and prioritising the households most at risk, mitigating risks where possible and planning for possible scenarios, including infections within the home and Shared Lives carers being unable to care. We have outlined fast-tracked procedures to get new support carers approved.
  2. The key message from our guidance on supporting Shared Lives households under pressure is to help the household build its resilience and two kinds of connections: with other Shared Lives households and with neighbours. We are aiming to get a new Positive Behaviour Support advice service up and running shortly if we can resource it. We’re helping members share what’s working and the team are taking calls where people are struggling.
  3. We have been ensuring that Shared Lives carers, and community care services more generally, are being considered along with other social care services, for PPE and giving practical advice. The UK’s failure to plan for PPE demand mystifies me and has left thousands of the people we rely on most at unnecessary risk. This appears to be being rectified, but local problems are still huge. We’ve written to all the supermarkets explaining what Shared Lives carers and Homesharers are why they need access to food.
  4. Government announcements are imminent about support for the self-employed. In the meantime, our advice to Shared Lives schemes has been: do everything you can to support your Shared Lives carers. We will need everyone during this crisis and in the recession which will follow it. Councils have been given funding to support stability in the social care sector, and the good ones are using it to keep providers afloat and social care workers in this vital workforce. We are supporting Shared Lives schemes to identify their spare capacity and consider how Shared Lives carers who are not currently working can safely support households who are struggling, and respond where possible to the need to discharge thousands of people from hospital. Virus testing, adequate PPE and ensuring people and organisations are working as part of one team will be vital in making this work.
I’d like to thank the 10,000 Shared Lives households and 500 Homeshare households who are contributing so much to keeping people safe and well during this crisis, and the Shared Lives Plus team who have made me so proud to work for such a great charity these past couple of weeks.
James and Bronte
James and Bronte digging vegetables at home, taken by Shared Lives carer Andy

Alex Tweets @alexsharedlives 

Thursday, 26 March 2020

COVID-19: using digital technology in relationship-based practice to bridge the gap in social distancing

By Dr Godfred Boahen,  Policy and Research Officer, British Association of Social Workers

Among one of the many challenges of the ongoing COVID-19 crisis to social work is how to conduct relationship-based practice from a distance. Social workers recognise the inherent ethical and therapeutic value of social relationships. We believe that it is ‘good’ and ‘right’ for people to maintain social bonds with their families and social networks. This is because a core social work value is recognition of peoples’ humanity and worth, and this is also underpinned by the principle that this occurs within interdependent human relationships, which also enable humans to flourish. Generally,  people experience love, care, and support within their social networks. Even in caregiving dyads, persons receiving support have opportunities to contribute to the wellbeing of their carer – so these relationships tend to be interdependent and they generate options for both parties to feel empowered and improve their self-worth. Aside from the moral and ethical value of relationships, social workers can draw on them therapeutically, to support people to change (Ingram and Smith, 2018).

However, when it comes to relationships, in social work, the prevailing assumption has been that they involve people being in physical contact within the same space. It is probably for this reason that ‘the home visit’ is such an important part of social work practice.

For these reasons, the ongoing COVID-19 crisis is a serious challenge to social work because the emergency requires the profession to alter how relationship-based approaches are framed and practised. One cause of this is the government’s social distancing guidance which is a policy aimed explicitly at minimising peoples interactions to reduce the rate of infection transmission. How do you maintain relationships with people who use services if you cannot visit people regularly? How do you keep people safe and well if you cannot assess their living spaces? How can we model ‘good’ behaviours and encourage people to maintain change when we cannot see to ascertain their physical and emotional demeanour?

The role of digital technology
Social workers can use digital technology in creative ways to initiate, maintain and sustain relationships to meet the emotional and therapeutic needs of people who use services.

Keeping in touch with people
During this period of uncertainty and rapid change, it is easy for social workers to lose regular contact with people in order to maintain existing relationships. There are a range of technologies that can enable social workers to keep in touch with people who use services -e.g. Skype, Zoom, MS Teams, Slack, Google Hangouts, Facetime and WhatsApp. Through these applications, social workers can either call or text people who use services to ensure that they are safe and have food at home to maintain their wellbeing. In relationship-based terms, social workers can call to let people know that they are thinking of them, to demonstrate care and compassion for people who may be alone and therefore feeling excluded. This is going beyond the procedural aspects of social work – it is about humane practice, recognising our mutual need to know that people have our interests in mind at a time of crisis.

Involvement and co-production
One reason why relationship-based practice has such an important ethical status in social work is because exemplify other social work values. To have a genuine professional relationship with people who use services, social workers have to recognise that they have as much power as the professional to determine the nature of their engagement. People have a right to be heard and consulted about decisions about their care, they have to consent, and they need to be included in service provision. Digital technology enable social workers to keep to these principles even in this time of social distancing. We can email assessment and care plans to people to ask for their feedback and comments, through video-conferencing people can participate in inter-agency professional meetings about their care and a host of online apps allow people to express their wishes. As this technology is available, even in this period of social distancing, social workers can keep to the key tenets of relationship-based practice around inclusive practice and co-production. 

Supporting people to access the internet 
With social interactions reduced at this period, people who use services need access to the Internet to receive information and maintain contact with their family and professional networks for the safety and wellbeing. This makes access to the Internet data an important need. Social workers therefore need to think of creative ways in which exiting care plans (and packages) can be reviewed to take account of this new context of need to access the Internet. Mobile charges to NHS information have been removed – this means that people who use services can maintain the relationship they had with NHS staff and networks prior to the COVID-19 social distancing restrictions. 

Co-researching online support networks with people who use services 
Recently, there has been a strong focus on strengths-based and asset-based models of social work practice. In these approaches social workers seek to identify what people can do for themselves alongside co-production of care plans to identify community resources for support (Baron et al, 2019). Although because of social distancing rules people cannot access the physical spaces where services were located in their geographical areas, social workers can use digital technologies to continue to uphold these principles. Being creative, social workers should continue to draw on peoples’ strengths and desires to socialise and form relationships and work with them to identify online self-management groups and support networks. Some people who use services may also have had active social lives centred on accessing community-based services, physically. Social workers can assist them to channel these exiting strengths into creating new online networks. 

Concluding thoughts 
I have argued that while challenging, current digital technologies provide options for us to fulfil the values and ethics of relationship-based practice in this era of social distancing. It has been assumed in social work that most social interactions are desirable and as such, social workers seek to enhance relationships. Longstanding practice models – for instance group work and community practice – are based on relationships happening physically in time and space. The question to address is how to maintain social relationships when this can elevate public health concerns.  While not a substitute, digital technologies can facilitate social workers to maintain contact with people, talk to them and assess their needs and signpost them to people who share the same life experiences with them. This time of crisis presents an opportunity for social work to re-think the meaning of relationships without losing sight of their core moral and ethical worth.


Wednesday, 25 March 2020

What is worrying social care providers and their staff

By Melanie Weatherley MBE, Chair, Lincolnshire Care Association

This is a very challenging time for those involved in caring for the most vulnerable in society. Like our colleagues in the NHS we are worried about the effect on our workforce as people self-isolate and the need for the appropriate levels of PPE to keep service users and our staff safe.

SCIE: Coronavirus (COVID-19) advice for social care

We are also concerned that our staff, who are working hard to cover colleagues who are unavailable, and supporting individuals who are understandably anxious, are going shopping at the end of a difficult day to find no food in the shops. This is being made easier with some designated time for keyworkers to shop, but perhaps the hubs being set up to support those who are being sheltered for 12 weeks, could support key staff if they have no-one else to shop for them.

A similar growing concern from our care homes, is that they are also finding that food is becoming difficult to buy. Smaller homes support their communities by using local shops and supermarkets, but again have been finding the shelves empty. Care associations are working with local authority colleagues to try to mitigate this. But, when you reach for that extra packet of pasta, or carton of eggs, please think if you really need it. Remember that this might mean that your local care home are wasting valuable time searching for the food that their residents need.

Providers of care at home are particularly concerned about the impact of staff shortages. We know that being supported by the same small group of care staff at a regular time is very important to our service users, but to make it possible to provide care to all those who need it, we may need to visit at different times, and using different members of staff. These changes are not something that will be introduced lightly, and we ask for understanding from our service users and their families.

Another pressing concern is the need for care organisations to be sustainable. This is not a sector which is particularly well-funded, and many providers are experiencing reduced revenue as people self-isolate, and rising costs to maintain levels of service. Additional support has been made available to NHS organisations and businesses which have had to cease or curtail their activities, but nothing yet to enable us to continue our vital services. 

Tuesday, 24 March 2020

Covid-19 and adult social workers

By Rob Mitchell, Principal Social Worker at Bradford Council and Elaine James, Service Manager for commissioning for learning disabilities at Bradford council

Social justice, human rights, collective responsibility and respect for diversity.
Those principles underpin the professional ethics which are encoded into the global definition of social work. During the current Covid-19 pandemic, the professional ethics and moral code of the profession at a global level is being tested.  At a time when the World Health Organisation asks for ‘social distancing’ to be adopted be everyone on the planet, never has the social in social work mattered so much. 
Since the Care Act was brought into law in 2014, adult social workers in England have reconnected with the social in social work; moving away from transactional brokerage roles, developing relational practice which focuses on people’s strengths, and building on natural social networks of support within their family and community.  At a time when these networks are physically distanced, the profession has a key role in maintain wellbeing. 

In our Local Authority our social workers are doing the following:
A lot of social work attention in the coming months will be on supporting our NHS colleagues, working collaboratively and collectively to ensure that clinically skilled nurses and doctors are able to prioritise and concentrate on those who most need their care. We have a strong ethos of helping people to stay happy and healthy at home in Bradford.  There will be an enhanced role for social work in the coming months, helping commissioners to understand what support people need to do this, and whether people’s needs are changing and different to what they might usually been.
People will need to see, speak to and hear from social workers more than usual over the coming months. Our social workers are becoming familiar with the Government guidance on who is most vulnerable from Covid-19, reviewing and checking is anyone they or their team support affected.  They are making contact with them, ensuring they have accessible information about protecting themselves and their family from Covid-19 and arranging for weekly phone and video calls to check in.  If they are extremely at risk from Covid-19, they are making contact with the community hub to ensure that they have a regular supply of food, medicines, toiletries, household and personal hygiene goods.
Article Eight of the European Convention on Human Rights is the right to a private and family life.  There are lots of modern technologies out there that can help maintain social and family networks: Zoom, Skype, Facetime and Whatsapp are all easily accessible and we are encouraging families and Care Home providers to set up and use them.
Direct Payments – Regulation 11 of the Community Care, Services for Carers and Children’s Services (Direct Payments) (England) Regulations 2009 makes clear that  that direct payments can be used to secure services from these people (including parents) where the local authority is ‘satisfied that securing the service from such a person is necessary…for promoting the welfare of the child in respect of whom the service is needed’. This means that social workers are permitted to make Direct Payments for a disabled child, to employ close family members living in the same household to provide care. The only requirement is that the Local Authority accepts that this is necessary for promoting the child’s welfare.  Under Regulation Three of the Care and Support (Direct Payments) Regulations 2014 social workers can in exception agree to Direct Payments being used to pay close family members living in the same household to meet care needs ‘if the local authority considers it is necessary to do so’.  We have decided that during the Covid-19 crisis we will adopt the presumption of necessity and use Direct Payments very flexibly.
So, we’re sticking to those principles of social justice, human rights, collective responsibility and respect for diversity. Social work can play its part in helping us all get through this crisis and beyond.

Sunday, 22 March 2020

Covid-19: An older person caring for a young family member

By Dame Philippa Russell, Vice-President, Carers UK - and carer for her son Simon

The Government’s guidance for care homes and supported living, on living with Coronavirus, cannot cover the large group of older family carers – like myself - who have embraced personalisation, independent living and ‘ordinary lives’ for our adult children with learning disability/autism. The war against the Coronavirus grows fiercer by the day and we are terrified by the prospect of enforced ‘house arrest’ for maybe four months or more. 

SCIE: Coronavirus (COVID-19) advice for social care

Of course, older people like myself are more vulnerable to any virus. But many of us are fit, healthy and we are still the lynchpins of our adult children’s lives. Sadly, we live in an ageist society, where maturity is all too often confused with incapacity and ‘burden’. Like many in my generation, I have lived through epidemics and I fully understand the importance of preventing transmission and of course the judicious use of social isolation. 

But ‘house arrest’?  Simon, my son, values his own home, he loves to get out and about in Chichester. But he can’t Skype (he can’t read or write or use any IT equipment). He finds telephones difficult and he needs active support and companionship with daily activities. If I am ‘locked in’, what happens in his empty hours? 

There are 168 hours in a week – we are lucky because Simon has a fantastic support worker for 30 of those hours. In a normal week he would also have around 25-30 hours of supported activities in the local community. But those activities are all shut down by coronavirus.  So what about the remaining 138 empty hours?  

Like many family carers, I am terrified of the prospect of being locked out of Simon’s life with no reliable replacement.  Unfortunately there is no ‘remote access’ for family carers like myself or those we care for. For us, care and support are ‘face to face’, often a marathon in the best of times. 

For me, the present situation underlines the vulnerability of the huge progress made in the last couple of decades (and epitomised in the Care Act) around personalisation and good lives in the community. Looking at Simon’s artworks, at his garden and the home he loves, I see the vulnerability of our health and social care sectors and I dream of the ‘re-imagining’ of social care that has been promised so  often but remains a dread.

As an anxious family carer, I am worried by the implications of the Government’s Emergency Powers. With no vote (and thereby no time for real debate) local authorities will be permitted to reduce their normal standards of care and ‘prioritise’ and the NHS will be allowed to discharge elderly patients early from hospital. In the war zone we all live in, this may make common sense. But who decides what is fair and equitable  – and will people like my son, not living in a group setting and with one ‘older’ parent still alive but maybe put in solitary confinement, be remembered and valued in the distribution of scarce resources?   

So what is the solution?  My family came from New Zealand in the 1940s and we were promptly bombed out of our house. There is something very salutary about being a ‘child of the Blitz’ because when you lose everything, you have no choice but to be solution focused!  We haven’t lost everything. We have the Care Act, we have the NHS Long Term Plan and we have committed and creative family carers and of course our amazing care workforce – 1.34 million people, often undervalued but incredibly skilled, I couldn’t have coped with my husband’s illness and Simon’s disability without the ‘co-production’ we built together.  Surely now is the time to give ‘parity of esteem’ to health AND social services as both being inextricably linked in ensuring good lives for vulnerable people?

Talking about ‘co-production’, and thinking back to the Blitz and Churchill’s dictum that ‘you need people’s hearts and minds to win a war’, maybe we could start by actively engaging family carers, disabled people and their organisations in the campaign against the Coronavirus?  Most Local Authorities have resilience committees of some kind – but are they listening to people like me, to our local networks and organisations?  In hard times, do they even know that we ‘hidden carers’ actually exist?  Today, after another alarming news programme on his TV, my son told me he couldn’t sleep at night because he was scared I might get ill or die in the night – and who would tell him?   ‘Social isolation’ may minimise infection, but it threatens the quality of our lives (and any care and support needs) where relationships are crucial. 

If the Coronavirus crisis has one good outcome, I hope that at last it will trigger the long awaited public debate about what we mean by 2lst century social care. Like the NHS it is now so much more than a safety net and so much more about enabling citizens like my son to have a good life. 

What should I do if all my PAs suddenly had to self-isolate?

By Ossie Stuart,  SCIE trustee & equality and diversity consultant

During these anxious times, of all the questions I have, as a user of a direct payment to employ my own personal assistants (PA), this is the one that has not been answered. Of course, there is the ever-present fear of contracting Coronavirus virus, that causes the disease - Covid-19. Yet, people like myself or those who pay for their own care also have to worry about what to do if our key workers, our PAs, were to contract it, too. Even with suspected symptoms PAs they must isolate themselves for at least seven days, as advised by Public Health England. An event that would immediately deprive us of the support we need.

SCIE: Coronavirus (COVID-19) advice for social care

Let's think about that for a moment, shall we? The main reason why people choose to employ their own PA is to maintain their own independence and, with it, their dignity. I have a long memory of being humiliated, bullied and abused in a care home setting as a teenager. As a consequence, for many this is often the only way to meet their care needs. For example, people may work and have unpredictable schedules to keep, as I do. 

Or, they may have complex needs that require specific assistance that care agencies are often unable to provide except at considerable expense. These can range from people with learning disabilities to people living with dementia. The PAs who work for us are highly trained and extremely flexible. They could be, for example, supporting someone with very complex communication needs. Or have to support the unpredictable schedules that people like myself must follow simply to earn a living despite this coronavirus emergency. 

To lose just one of these skilled workers would be devastating. To lose them all would be catastrophic. Irreplaceable at such short notice, they cannot be substituted for "informal support" nor replaced by untrained voluntary support that might be found at short notice. It is a fact that the government, for all its helpful advice, appears to have forgotten or, worse, not fully understood. 

There is no one single source of good advice that a person who employs their own assistance, with or without a direct payment can go. The advice that does exist is, literally, all over the place. An intensive search today found 12 websites, each of which added to the jigsaw, but none answered my key question.

Public Health England is the go-to place for all information regarding the coronavirus and COVID-19. The information there is excellent but very dense and, therefore, difficult to access. It would appear that the information is designed for health professionals rather than the general public. This is unfortunate because the majority of the social care guidance organisations, such as Skills for Care and even SCIE will point you to this information as well. For health professionals these are the ideal websites to go to obtain the latest advice. For us, people who employ our own PAs, the best advice is to find the guidance on our local authority websites. In my case this would be Camden Council.

Called, “Camden Care Choices, information advice, Coronavirus (Covid-19) latest guidance”, although very difficult to find, Camden Social Services website provides a whole host of very helpful advice. If you live in Camden it is essential viewing. Even if you do not, it is still worth a visit. At the very least you will get an idea of what you should expect from your own local social care service.

The site provides advice about who to contact if you have any issues with maintaining your care. It provides very important information about financial support on offer if you have to pay a PA statutory sick pay (SSP). To my amazement Camden Social Services has now allowed us to spend our direct payment “more creatively” during this crisis! Finally, they trust us to spend our direct payment responsibly! Unfortunately, despite this all this advice they fail to answer the question I posed at the beginning of this blog. What should I do if all my PAs had to self-isolate?

Their reply is to contact Adult Social Care. By then it would be too late. What I really need is help to build resilience and redundancy into my system now. I can do this by employing more people for more hours to reduce the risk that I cannot maintain the minimum level of support I need. Yes, this will come at a cost. Yet, if the Government wants local authorities to remember those who are directing their own care, too, as it has to clearly stated, then this is the only way to ensure we can also continue to live in the community and contribute at this time for crisis.