Case Study Talking Points Outcomes Framework

1. Case StudyTalking PointsOutcomes Framework Josephine Wight Team Manager Older People’s Team – Levern Valley East Renfrewshire CHCP

2. Good Afternoon My name is Barbara Cole and I am 77 years old. I am sorry I cannot meet with you today as I have a concert to attend Josephine will tell my story

3. My Story My Life • Barbara collapsed on the stairs at Strathclyde University as a result of a brain haemorrhage in August 09 • Due to the fall, she sustained a shattered skull and further bleeds to her brain • Barbara was treated at the Southern General Hospital, then transferred to the Royal Alexandra Hospital on the September 09

4. Who was she? • There was only basic information about Barbara • I heard of her story on the STV news • Barbara was a volunteer tour guide with Strathclyde University prior to her accident • She originated from the Midlands • Barbara is single • She had a good network of friends and attended her local church on a weekly basis • She has no next of kin • Barbara does not recall much about her personal circumstances as a result of her head injury.

5. Shared AssessmentTalking Points Personal Outcomes Approach The ‘Exchange Model’ is used by the team to allow the outcomes approach to be taken within assessment. This allows the strengths and aspirations of the person to be explored and build on their capacity. Acknowledging core areas must also be covered • Barbara had been a well and fit lady • She had attended University in her younger years • She has interests in history, archiving records, her computer and photography • Barbara lived independently • She had signed up for two further education courses with Strathclyde University for the year 2009/10

6. Barbara’s Hospital Report • She mobilises with a walking frame but has no recall on how to use her walking frame as a result of cognitive impairment • She requires supervision from staff to ensure that she is using a walking frame safely as she is at risk of falls • Ward staff advised that there are times during the night when Miss Cole gets up to mobilise to the toilet and then forgets the location of the toilet or her bed • Barbara has expressive dysphasia • She requires support with speech, reading and writing • She requires prompts with all activities of daily living

7. Risk AssessmentModified Sainsbury • Barbara failed in every area except one – Moving and Handling • Risk from others • Risk of self • Risk to others • Risk of physical impairment • Memory & Cognitive Impairment • Falls • Environmental Risk • Challenges to services • Risk of wandering • IoRN score I

8. What was the outcome of the hospital assessment? • The Questioning Model and Procedural Model led to the decision and subsequent referral to East Renfrewshire CHCP for ASSESSMENT FOR LONG TERM CARE

9. Outcome Focus AssessmentEast Renfrewshire CHCPWhat did Barbara want?

10. Talking Points

11. This is what Barbara wanted‘Her Outcomes’ • Being as independent as possible to live her life • To live in her own home • To feel safe in her home and in her community • To see her friends • To be well • To be fully occupied with her interests and hobbies

12. How did we know this? • We listened to what she said and helped her express herself • She had her say • She was treated with respect • There was reliability with the staff and processes • Barbara was responded to for the person she was and is

13. What happened? • Her confidence improved • Her morale improved • Her motor and processing skills improved • Her condition improved • She regained her capacity to make decisions for her welfare • She has day to day spending control of her finances

14. Who did all of this? • Barbara • Social Work Assistant • Occupational Therapist • Physiotherapist • Older People’s Team Assistant • Speech and Language Therapist • Community Psychiatric Nurse • Consultant Psychiatrist • Mental Health Officer • Independent Advocate • The Firs Care Home • Team Manager

15. How was it achieved? • Multi-disciplinary working • Outcomes focus assessment • Mental Health Legislation used with the least restrictive option • Independent Advocacy • Care Planning • Implementation • Reviewing

16. Then What? • Transfer to care home – intermediate care • Rehabilitation programme set • Risk Enablement Assessment, this remains constant • Implementation • Phased Integration into Barbara's community • Continue to review and continue implementation • Final goal achieved by Barbara achieving her outcomes

17. Risk Assessment What risks remain outstanding for Barbara? • Risk from others • This is the same risk that anyone would have living their life. The risk is slightly higher for Barbara. However, she requires no interventions as she can live with this and so can we!

18. Today • Barbara is back living in her own home • She is independent with all activities of daily living • Guardianship for financial matters, Barbara has control of her day to day and week to week finances • Barbara works with her computer • Entertains her friends and is a fantastic cook • Participates in the life of her church • Does voluntary work with Accord Hospice • She participates with her interests and hobbies, this work continues • She goes out and meets with friends • Goes out independently to outings that have her interest which include complex travel arrangements to get to • She has no services • IoRN score A

19. Thank you