BOX 9

A summary of the main themes identified in the RAM Panel discussion

Main themeCoverageNumber of case types related toQuotes
The desire to support the service user at home
  • Can the person’s needs be met at home?
  • Has home care been tried/exhausted?
  • Could technology/adaptations help?
  • Would a staged return home help?
  • There is family support at home
  • This is what the family wants
  • This is what the service user wants
9

  • Why can she not return home? Because that’s what we’d be looking to do . . .

  • There was no care package, at all, going in to support this lady and this couple before she went into hospital . . . I think what we are saying is that there is still work to do to explore what can be provided in the current home environment

  • He’s quite clear he wants to go home. That’s what he’s stated although he doesn’t have capacity, but that is his overriding wishes . . .

Risks
  • What are the risks of maintaining the service user at home?
  • How can these be addressed?
6

  • The fire risk seems to be the one that comes out in terms of activity relating to food preparation, doesn’t it? I suppose it’s how we deal with that

  • I guess the risks are beginning to really sort of be significant, in terms of clearly life and limb aren’t they, in that sense?

Arguments against moving the service user from their home
  • The absence of indicators for 24-hour care
  • The desire to avoid premature moves
  • The desire to avoid multiple moves
6

  • Let’s start the other way. Do we feel that he needs some form of residential care or not? Does he need 24-hour supervision?

  • What would extra care housing give her that we couldn’t provide by enhancing her care package?

  • . . . presumably she might not want another change of accommodation

The likelihood of the home situation improving
  • The possibility the service user’s presentation will improve per se
  • The possibility further assessment will lead to interventions to improve the situation
5

  • There’s too many issues not bottomed out . . . We’d want to know about what the dizzy spells are linked to. I think that needs fuller investigation

  • . . . understand whether this is, is this a continuation of a deterioration of his vascular dementia . . . or is it something that can be addressed?

The service user’s concerns/best interests
  • How can we address the service user’s concerns about staying at home?
  • How can we engage the service user with home care?
  • What is in the service user’s best interests?
  • The desire to promote the service user’s independence
5

  • I think anxiety is going to be a key issue to overcome . . .

  • My worry would be she’s resisted it up to now. If you go in with four calls a day of 45 minutes, I wouldn’t have thought straight away that’s necessarily going to be an option. I would have thought if you go in top heavy rather than build it up slowly, build it back up

  • I wonder as she’s taken a dislike to particular carers, perhaps we could encourage her to take a direct payment and perhaps employ her own . . .

Carers’ concerns
  • How can we address the carers’ stress?
  • How can we address the carers’ worries about the service user staying at home?
3

  • What are we going to do to actually try and prevent the, or reduce the volume of calls that Mrs F is making to her daughter, because that appears to be a key pressure area . . .

  • I suppose we are looking to see what additional support can we provide within the home to support the husband

From: Chapter 5, Services for older people with mental health problems. The North-West Balance of Care Study: findings II

Cover of National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes
National trends and local delivery in old age mental health services: towards an evidence base. A mixed-methodology study of the balance of care approach, community mental health teams and specialist mental health outreach to care homes.
Programme Grants for Applied Research, No. 2.4.
Challis D, Tucker S, Wilberforce M, et al.
Southampton (UK): NIHR Journals Library; 2014 Sep.
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