Who does what in health and social care?

[LancsHotpot]

My Mum (77) has pretty much stopped eating. There doesn't appear to be a physical cause, she's had a variety of tests, scans and endoscopies and there's no discernible reason. She manages a couple of yogurt drinks from the doctor, and can still drink plenty of alcohol - she has been an alcoholic for at least 40 years.

She is now very weak, struggles to get up, falls, is incontinent and is becoming very confused. She's not able to get upstairs and doesn't wash or change her clothes unless the carers do it. My Dad is struggling to look after her and physically lift her.

They have had an assessment by a social worker and have emergency carers twice a day. This is in place until the assessed care package is implemented. They have bought some grab rails, a raised toilet seat and lots of products for the incontinence. We'll be getting a stair lift fitted, and a falls response service in place soon. My parents will be funding the care and any aids and adaptations.

One of the problems is that they live very close to the local authority boundary, and while social care falls under their local council, their doctor falls under a different one. No one seems to know who is responsible for what. Is there anyone who knows what falls under social care and what falls under health care?

I just don't know who to approach to try and follow things up. For example I think she needs a recliner chair to reduce the falls when getting up from the chair. My Mum won't have one, but might be talked round if a professional said it was necessary. Would this be health - as something that may help reduce the chance of an admission to hospital - or social care? Or does no one recommend these? I don't know what I'm doing - they might be entirely inappropriate - but I don't know who to ask!

I’m sorry that this is your situation.
if your parents are funding the care and are comfortable doing so it is probably easiest to just purchase the chair yourselves. Would Mum listen to the carers/ manager of the carers? Would Dad be willing to just buy one and then encourage Mum to use it?

long story short, the divide between health and social care often isn’t clear and local authorities and CCG’s (health) spend a lot of time discussing and arguing about some issues and instances.

as a simple approach, things to do with washing, dressing, accessing meals, getting out and about, running a home, using a toilet, getting around the house = social care (but not all needs will meet the eligibility criteria)

things to do with improving or maintaining health or treatment =health.

so it can be a fine line . For example the health service might provide incontinence pads but social care might provide someone to help the person change them.

to make it more complicated social care will sometimes do health things because it doesn’t take a moment to do them if they are there any way. As examples: handing someone their tablets as the carer is there helping with a meal at the right time. Tablets are health things so social care wouldn’t send someone in just to give tablets but doing so when it is “ancillary “ to a task they are there to do anyway is fine.

the under lying thing to look at is the eligibility criteria within the Care Act 2014 as that will help to explain what the local authority has a duty to do/provide.

When we wanted to get medical equipment for my mum I sought the advice of the district nurses. They told me what to buy for her. She could have had it on the nhs but there was a waiting list

Thanks for the replies. My Dad could buy a chair, but he has done what he's told by my Mum for 50 years and is finding it difficult to break the habit! She is not the easiest woman in the world to live with and he tends to take the line of least resistance with her, which is not always that helpful.
The healthcare people provided risers for her existing chair. I'm not terribly sure why it was them and not the social care people though.

The healthcare people provided risers for her existing chair. I'm not terribly sure why it was them and not the social care people though. It would be recommended by Occupational Therapy which in our area comes under District Nurses, ie Health.

There are areas of overlap between professions and services and it dies vary between different areas, a bit of a postcode lottery really. A physiotherapist or occupational therapist would be best placed to look at your mums sit to stand ability. They could then advise about the most appropriate height and width of a chair.

Sorry you're finding this all so confusing. Chairs are assessed for by occupational therapists, and this can be done through both social services and health treats. The team that assessed her for the stair lift should be able to assess for a recliner too.
The GP being in a different borough is a bit of a red herring. That's not unusual, and the usual process would be for the necessary teams, both social service and health (community rehab, falls prevention etc) would come from the borough they are living in. That's because it's their home borough that will find care, equipment etc. District nursing services can differ slightly so that will depend on the policy in the area, but I imagine she would be seen by the DNS from her home borough too.
If it's possible then changing to a GP in the same borough is probably not a bad idea.

"Teams" and "fund"!

Thanks for the replies! No one has assessed her for a stair lift - we are getting one fitted independently. I'll speak to her social worker tomorrow and ask about a physio/occupational therapist assessment. I don't want to be getting equipment that makes things worse! It's just that it's taken so long to get to the point that they will accept any help at all and I just want to get things that will help my Dad in place as soon as I can.

Word of warning - my local authority is no longer funding rise recline chairs (except for people with very low incomes), so your parents may be expected to buy their own. Occupational therapists may be part of health or of social care or there may be integrated teams (in Scotland there are NHS OTs and council OTs working in the same team).

I would hold off on the stairlift tbh, they are very expensive, almost impossible to get rid of and people need to have balance to use them. They are not really safe for someone who is very confused and falls, they can find them difficult to get on or off and some people try and get off midway down the stairs. I would wait till they have had assessments, dad can have a carers assessment. Has the doctor seen her if she is very confused, does she have mental capacity to be making decisions and js their home safe for them.

There are grants available for small adaptations and OT can supply them. The disrrict njrse can also arrange a continence assessment and pads on prescription, you can also get extra waste bins for continence products from the council.
Your dad should not be lifting her, thats a risk to both of them, have they got a careline and keýsafe system set up.
She sounds unwell which may all be caused by long term alcohol, she should have a review with her doctor or community nurse first.
Financially they can claim attendance and carers allowanxw.

She has seen a lot of doctors. I took her to A&E in May and she was admitted and had lots of tests. She's had more tests since. They seem to have looked at everything, particularly her liver, and can't find anything out of the ordinary for someone of 77. I went to her recent consultant's appointment - they were clear that she doesn't have cirrhosis or cancer. She just seems to be ill because she isn't eating.

I made her last GP appointment and went with her. They did a brief memory test - she could count backwards from 20 and remembered most of the address she was given to recall. They prescribed an antidepressant and didn't want to do anything else, even though she was adamant any confusion had been caused by her moving house (she hasn't moved house for 40 years). I don't know if that's because she drinks and won't entertain stopping - it seemed to me that support may be available for those who want to stop drinking, but not for those who don't.

She has an appointment for an incontinence assessment. She is not great at wearing the pads she's got though, nor does she want to change her clothes.

Anyway I rang the social worker who thought the healthcare authority should have assessed adaptations for the house. They haven't, so she will see if she can get this done through the social services borough but there's a probable waiting list of 15 weeks.

They got a Careline falls responder service fitted today. My Mum tells me it's a burglar alarm though, so I am not convinced she will wear the pendant or engage with a caller if she falls.

I'll look at Attendance and Carers' Allowance. They're not short of money though, it's just getting them to spend any of it!

It's rubbish all this isn't it? I'm new to it, my heart goes out to people who have dealt with it all for years.

It is very difficult getting help set up, has she ever had brain scans, have the doctors investigated her for alcohol induced dementia or an infection.

I don't know. Her head was scanned when I took her to A&E because of the falls, but the confusion and memory loss is more recent so I don't know what they were looking for.

I've just had a quick look at Alcohol Related Dementia and Wernicke-Korsakoff Syndrome and I think you've nailed it! I just don't know if there is anything that can be done if she won't give up alcohol (and she absolutely won't).

She has another GP appointment next week so I will gatecrash that and speak to the doctor. Thanks!

Do ask the doctor for tests and blood tests, high dose vitamins can be given. The scans after the fall would have looked for any fracture or bleeding. If she wont give up drinking and is getting worse then a frank open discussion needs to take place with her doctor about her future care and both their safety.

She had blood tests recently and the GP has called and prescribed 3 new things today - vitamin D, folic acid and something else that they thought my Dad might want to discuss with me. Unhelpfully he has forgotten what it is! Hopefully he'll be able to tell me when he picks up the prescription.

The health authority rang and will be assessing walking aids etc - hopefully tomorrow - so we have progress. I can't be there for that but have given him a list of things to ask about, including advice on whether a stair lift is recommended, any advice on a recliner and a seat for the shower.

At least things are getting done now, I wonder what the other medication is. If she is very unsteady would she be better having her bed downstairs.

The local authority's Lifting and Handling Team have also called and said they will do an assessment tomorrow. I'll be able to go to that one. Honestly you get no aids assessments for ages, then two come along at once! I'll leave it to them to sort out who is recommending and paying for what.

She is sleeping downstairs and has not been up the stairs for months. Unfortunately there's no shower downstairs, just a toilet and basin.