Community Care Roles Explained

“Community care is all about providing physical, emotional and social support to help people live their lives independently and with dignity and control.”

Zuva talks us through roles in Community Care and explains how they work in relation to patient care.

Topics covered in this article

Introduction

Carer

GP (General Practitioner) and Doctors

Social Worker

Occupational Therapist (OT)

Care Assistant

District and Community Nurses

Admiral Nurse

When Care Needs Change

NHS Continuing Healthcare Co-ordinator

Care Home Manager And Staff

Introduction

Community care is all about providing physical, emotional and social support to help people live their lives independently and with dignity and control.

With many job roles at hand to achieve this, you many ponder, at what stage do each of these roles become involved in a person’s care?

To get a better understanding of this, meet Adrian.

Adrian is 80 years and shows symptoms of early on set Dementia.

Although not yet diagnosed, Adrian has been having difficulty with his memory and sometimes needs help with day-to-day tasks like shopping and reminders to pay bills on time: tasks he’s previously been able to do with no problems.

Adrian is married to his wife Josephine but recently she was admitted into hospital because she fractured her hip after a serious fall.

Even though Adrian is somewhat independent he did rely on his wife to carry out certain tasks of day to day living.

Now on his own, who will assist Adrian?

Carer

Well, interestingly, the first role involved in his care is that of the people closest to him, such as other family members and/or friends and neighbours.

They are the people who initially step in to help with things like doing his shopping for him but also are crucial in encouraging Adrian to go see his GP (General Practitioner) or Doctor.

The role of family and friends is very easily overlooked because it’s not usually a paid role and people don’t get trained for it.

The NHS defines a carer as “Anyone including children and adults who looks after a family member, partner or friend who needs help because of their illness, frailty, disability, a mental health problem or an addiction and cannot cope without their support.”

Sometimes people use the term “Carer” meaning paid Carers who are also referred to as Care Assistants.

Nevertheless, it’s important to note that family and people close to a vulnerable person play a vital role in their care especially in meeting their social support needs and this role often continues even when health and social care professionals become involved.

As I mentioned earlier, these family and friends help encourage Adrian to make an appointment to see the GP.

GP (General Practitioner) and Doctors

When Adrian visits his GP, he can expect them to ask more about his symptoms and other aspects of his health.

If possible, it would be helpful for someone who knows Adrian to accompany him to his appointment, so they can describe any changes or problems they've noticed.

They could also help Adrian remember what was said at the appointment, if this is difficult for him.

Now, because memory problems do not necessarily mean a person has Dementia, to help rule out other causes of memory problems, the GP will do a physical examination and tests.

If Adrian’s GP is unable to rule out other causes for his symptoms, they'll refer him to a healthcare professional who specialises in diagnosing Dementia such as:

* a Psychiatrist with experience of treating Dementia (an old-age Psychiatrist)

* a Doctor specialising in elderly care (a Geriatrician)

* a Doctor specialising in the brain and nervous system (a Neurologist)

Adrian was diagnosed with Dementia and the doctors discussed what this would mean for him and his lifestyle, the treatments they could offer him and planned to see him from time to time to see how he was managing.

Unfortunately for Adrian, the doctors also told Adrian to stop driving and as a result he gave up his license.

As part of these discussions, the GP also referred Adrian to adult social services for a care needs assessment.

N.B Anyone can apply for a needs assessment including the person in need of the assessment.

The NHS states: “If you think you, or someone you know, needs help to cope day-to-day, the first step is to get a needs assessment from your local council.” From this point onwards other health and social care professionals will be more active in Adrian’s care.

The professionals will co-ordinate the different types of support Adrian will need. At the time Adrian was diagnosed with Dementia, his wife Josephine was discharged from hospital and she was also referred to Adult Social services.

Social Worker

At their local council, a Social Worker carries out an assessment of their care needs first. It was decided that they would need:

* practical help from a paid carer (Care Assistant) who will visit a few times during the day

* changes made to their home to allow Josephine to move safely and prevent another fall

* equipment such as a walking frame for Josephine and a personal alarm to use in case she had a fall and was alone.

Occupational Therapist (OT)

For a decision to be made that changes need to be made to Adrian and Josephine’s home, an OT needed to assess Josephine in her home.

In this case the Social Worker through Social Services made the referral for the OT when they carried out the care needs assessment, but OT referrals can also be made by other healthcare professionals in the NHS such as hospital Nurses and Doctors.

An Occupational Therapist can also make referrals to a Social Worker for a care needs assessment.

During the home assessment the OT asked questions and walked around with Josephine to see what she struggled with.

Together, they decided on what she would need.

Care Assistant

A Care Assistant supports people with all aspects of their day to day living, including social and physical activities, personal care, mobility and meal times.

For Adrian and Josephine, a Care Assistant visits a few times during the day to help them with different things.

Adrian needs prompting to take his medication and assistance with meals. Josephine needs help getting washed and dressed in the morning and getting into bed safely at night.

District and Community Nurses

So far, we have seen the roles involved in Adrian and Josephine’s care but in Community Care there are many other roles.

Who they help, when they become involved and how they work with other professionals is dependent on the individual they are there to assist and their needs.

An important role is that of the District and Community Nurse, who are vital in keeping hospital admissions and readmissions to a minimum, by providing high quality care in the community outside of a hospital environment.

This could be anywhere from a patient’s home, GP surgeries, residential care home to schools and even on the streets with homeless people.

Often confused to be the same, the difference between the two Nursing roles is that a “Community Nurse” works in the community, with or without a specialist qualification whereas a “District Nurse” has completed additional training to become a specialist community practitioner.

In Adrian and Josephine’s case, a community or district Nurse maybe a part of their care if they ever require treatment that does not require a hospital admission.

Admiral Nurse

In some parts of the country, the NHS provides Admiral Nurses in partnership with the charity Dementia UK.

Admiral Nurses are NHS specialist dementia Nurses who will visit families to give practical guidance on accessing services as well as offering emotional support to people living with Dementia. As

Adrian’s dementia advanced, these Nurses were on hand to assist him but also offer much needed support to Josephine and their close friends and family.

When Care Needs Change

As Adrian and Josephine grew older, the time came when their care needs increased.

They needed someone with them 24/7.

At this point they had two options:

1. Receive 24/7 care in their home

2. Receive care in a nursing or residential care home

If they chose 24/7 care in their home, they could have:

* Live In Carers- People who take on Care Assistant duties whilst living in their home

* Live In Nurses- A Nurse living in, providing the needed care

NHS Continuing Healthcare Co-ordinator

Based on the complexity of their needs, Adrian and Josephine qualified for free social care arranged and funded solely by the NHS.

This is known as NHS continuing healthcare. Assessment for this is carried out by the local Clinic Commissioning Groups (CCG).

An initial checklist assessment is completed, and this can be done by a Nurse, Doctor, other healthcare professional or Social Worker.

Following the outcome of the checklist, Adrian and Josephine were referred for full assessment.

At this point, the Continuing Healthcare Co-ordinator was introduced.

Full assessments are undertaken by a multidisciplinary team (MDT) made up of a minimum of two professionals from different health and social care professions; some of which are already involved in the persons’ care.

Adrian and Josephine could receive NHS continuing healthcare in their home or in a care home.

If it was agreed that a care home is the best option, then the CCG would work with them to find a care home that’s suitable.

Care Home Manager And Staff

At the care home, it is the Care Home Manager’s responsibility to make sure there is enough adequately trained staff on hand at anytime to provide the necessary care for Adrian and Josephine.

They will also work closely with the multidisciplinary team responsible for their care.

All staff working in a care home, have a duty of care towards the residents to ensure their safety and wellbeing.