Does The Care Act 2014 Provide Dignity In Old Age?
On Dignity Action Day 2017, Clare English, one of our community care lawyers in Brighton, discusses whether the Care Act 2014 preserves dignity for people receiving care.
The news coverage about Ray and Jessie Lorrison late last year will have made many people angry at the perceived heartlessness of the Social Services department which had separated them.
Mr and Mrs Lorrison of North Tyneside, 95 and 88 years old respectively, had been married for 66 years. In August 2016 Mrs Lorrison suffered a fall at home and was hospitalised. Whilst she recovered, the family arranged for Mr Lorrison, who has Alzheimer’s disease, to move into a care home. The care home became Mr Lorrison’s permanent home but South Tyneside Social Services ruled that, after discharge from hospital, Mrs Lorrison should return home with daily care visits rather than join her husband in the care home.
Fortunately, thanks to the power of social media and an online petition, Social Services had a change of heart, agreeing that Mrs Lorrison could move to the care home to be with her husband.
Despite the happy ending in this particular “heartless Social Services” news story, Mr and Mrs Lorrison’s case illustrates that the introduction of the Care Act 2014 doesn’t make Adult Social Service provision more caring.
South Tyneside Council’s spokesperson said: “any decision on care and support for an individual is based on their own needs and is made in line with the Care Act. Where possible South Tyneside Council supports older people to remain independent and in their own homes…If a couple require the same type of care we will always try to ensure they remain together, but we would not automatically take away an individual’s independence to achieve that.”
This response is inconceivable to any reasonable decision maker. I am not sure that Mrs Lorrison, sitting on her own at home waiting for a 15 minute visit from an over-worked and under-paid agency carer, would have been thinking “well, at least I still have my independence”.
Unfortunately we have become increasingly familiar with representatives from Social Services creatively interpreting the Care Act 2014. The Care and Support Statutory Guidance (C&SSG) was issued to assist Social Services implement the Care Act 2014. It’s fundamental principles centre on the “individual” whose “well-being” should be preserved by meeting their “eligible needs”. But each person has their own “eligible needs” and too often “person-centred care and support planning” ends up in an outcome that denies people dignity in care.
The problem with the Care Act 2014, and the C&SSG, is that they promise well-being, which is difficult to quantify in a care and support assessment. The Care Act creates a general duty for Local Authorities to promote the “individual’s well-being”, (Section 1), tells Social Services to assess the individual’s eligible needs for care and support, (Sections 9 to 12), explains that the Local Authority may charge for that care and support, (Sections 12 to 17) and imposes a duty to meet the assessed eligible needs, (Sections 18 to 23). Unhelpfully, the Act does not define what well-being is.
None of this recognises that well-being can mean very different things to different people. No matter how many outcomes are met by a care and support assessment, all decisions need to be appropriate to the individuals specific circumstances.
Section 2.1 of C&SSG says “It is critical to the vision in the Care Act that the care and support system works to actively promote well-being and independence”. However, well-being and independence are not necessarily the same thing. This guidance had obviously been misinterpreted the Social Worker when assessing Mrs Lorrison’s eligible needs. This resulted in an irrational decision that maintaining her independence was more important than continuing to live with her husband of 66 years.
The C&SSG’s emphasis on eligible needs rather than individual choice often results in a person being reduced to a list of care needs. This approach does not provide dignity: none of us want to be described in terms of what we can no longer do for ourselves.
I believe that the Care Act’s obsession with prescribed outcomes means that those responsible for meeting older people’s care and support needs, forget to consider the individual as a whole. Asking older people how and where they would like their needs to be met is surely the first step in ensuring dignity is maintained?