1. 15/2/10 Social Work and Stroke This is not an Agored Cymru publication. It has been developed by colleagues from Cwm Taf University Health Board and is currently being hosted by Agored Cymru until a more suitable site becomes available.

2. Aims and Objectives Aim – to improve knowledge and understanding of the different issues and areas that the Social Work role in stroke can involve. Topics include - Benefits, financial issues and employment Protection of Vulnerable Adults The Mental capacity Act and the role of the Independent Mental Capacity Advocate (IMCA) Power of Attorney and Court of Protection Housing The role of the social worker and the importance of developing relationships with the service user, carer and multi-disciplinary team, and Some of the services and supports that are available.

3. What does a Social Worker do?

4. There are a number of vague concepts about what social workers do – ‘helping people’, ‘supporting people’, ‘making a difference’. The underpinning knowledge of Social Work comes from a range of sources – Social theory Practice models Evidence Based Practice approaches Practice Social research Law and policy

5. How to access social work Different local authorities operate in different ways and how a person accesses input and services can vary. Different local authorities are structured in different ways and are likely to have differing services available depending on the area and facilities.

6. On admission to hospital What issues do you think are important to consider from a Social Work perspective?

7. On admission to hospital Once over the initial shock and devastation of having a stroke, people start to think about practicalities. This can include their family, their house and their income. It depends on a persons’ circumstances as to how much input the Social Worker may need to provide at this stage.

8. Issues to think about Caring responsibilities Their property and pets Income employment and benefits

9. The protection of Vulnerable Adults While someone is under your care, you may have concerns regarding their safety. This could be a case of abuse and it is important that you raise your concerns via the protection of vulnerable adults (POVA) process for your area.

10. The different categories of abuse Physical abuse – unexplained burns, fractures, bruises, marks Sexual abuse – repeated UTIs (Urinary tract infections), unexplained soreness Psychological abuse - sharp changes in behaviour in the presence of certain persons Financial abuse – unexplained or sudden inability to pay bills Neglect and/or omissions – pressure sores, dehydration, weight loss, missed medication The above are the main categories of abuse and the following are other forms of abuse that fall into one of the above categories – Racial/homophobic motivated abuse Domestic abuse Self neglect/self harm Multiple forms of abuse.

11. Taking action Safeguard the vulnerable person Alert the right people to your concerns Make a referral to the designated lead manager for your area Keep records of incidents and details of witnesses, document injuries on a body map Work together as a team Attend a protection of vulnerable adults training course

12. Capacity The Mental Capacity Act 2005 came into force in 2007. The Act states that everyone should be treated as able to make their own decisions until it is shown that they are not. It also aims to enable people to make their own decisions for as long as they are capable of doing so.

13. Why do we need to know about the Mental Capacity Act? The Act impacts on all of our work. This includes Doctors, Nurses, Therapists, Social Workers, Home care workers and Care assistants. A lack of capacity could be because of a severe learning disability, dementia, mental health problems, a brain injury, a stroke or unconsciousness due to an anaesthetic or a sudden accident.

14. What is mental capacity? Mental capacity is the ability to make a decision Capacity can vary over time Loss of capacity may be temporary Capacity can vary in relation to the decision required Physical conditions, such as location, can affect a person’s capacity

15. What is lack of capacity? An individual lacks capacity if they are unable to make a particular decision at a specific time This inability must be caused by an impediment or disturbance of the mind or brain whether temporary or permanent

16. How do you assess capacity? Factors to be considered include General intellectual ability Memory Attention and concentration Reasoning Verbal comprehension and expression Cultural influences Social context

17. The capacity test A person is unable to make a decision for him/herself if he/she is unable - To understand the information relevant to the decision To retain that information To use or weigh that information, OR To communicate his/her decision

18. When someone is no longer able to decide The Act intends to protect people who lose the capacity to make their own decisions. Specifically it: Allows the person, while they are able to do so, to appoint someone, e.g. a trusted relative or friend, to make decisions on their behalf once they lose the inability to do so themselves – this is called lasting power of attorney and includes decisions on the person’s health and personal welfare. Previously, the law only covered financial matters under Enduring power of attorney. Lasting Power of Attorney replaces Enduring power of attorney. Provides a checklist for decision makers. This ensures that decisions are in the best interests of the person on whose behalf they are made. Introduces a Code of Practice for people such as healthcare workers who support people who have lost the capacity to make their own decisions.

19. The Court of Protection The Court of Protection deals will all issues relating to people who lack capacity to make specific decisions, for example concerning financial or serious healthcare matters. The Court of Protection can appoint deputies to make decisions for people lacking the capacity to make those decisions on their behalf.

20. Independent Mental Capacity Advocate The Mental Capacity Act set up the Independent Mental Capacity Advocate service. An Independent Mental Capacity Advocate (IMCA) is someone appointed to support a person who lacks capacity but has no one to speak for them, or represent their views (or no one appropriate to this role), such as family or friends.

21. The Mental Capacity Act Deprivation of Liberty safeguards (DOLs) The Mental Capacity Act Deprivation of Liberty safeguards apply to anyone - Aged 18 or over Who suffers from a mental disorder or disability of the mind Who lacks capacity to give informed consent to the arrangements made for their care and/or treatment, and For whom deprivation of liberty (within Article 5 of the European Convention on Human Rights) is considered after an independent assessment to be necessary in their best interests to protect them from harm.

22. Further down the rehabilitation path….. What issues do we need to think about and plan for? How can a Social Worker help?

23. Housing It may be that the person’s housing is no longer appropriate or no longer available to them. The Occupational Therapy Access or Home Visit may have highlighted concerns regarding their housing.

24. Practicalities and the bigger picture Big changes to a person’s life as a result of the stroke and the impact on family life and participation in the community What support is available to someone who has had a stroke and their carer in your area?

25. What else can help? A disabled car badge A reduction in bills Maximising benefits Support for Carers Relationship support Responding to individual need Help to return to work

26. What difference can Social Work make? Clinical guidelines recommend Social Workers as part of a stroke team Relationships with the service user, their carer and Multi Disciplinary Team (MDT) Reduction in delays More appropriate and flexible packages of care

27. In summary Social Work and stroke is a multi-faceted area of work. Funding and policy can vary from area to area, but the core values and the function of the Social Worker should be the same for the whole of Wales.

28. Thankyou Any Questions?