Inverse Care Law ... at Social Care's Door

Since 2015 I've had four 'conversations' with the doctors at A&E upon mum's attendance and subsequent admission on a couple of occasions. Initially, I was surprised if not shocked by the speed with which the 'conversation' followed on treatment, the extent of this and the question of resus. The further interactions were still emotionally jarring, even when expected and telegraphed. I also understand: to an extent. Repeated chest infection or urine infection had resulted in confusion, delirium that varied. on one occasion, at the nursing home there was also suddenly talk of a diagnosis of dementia, which prompted social services to wonder, like family and staff, where exactly this diagnosis had come from and investigate. (Another post?)

Mum has been very poorly, most recently in November. What surprised and shocked was the 'conversation' at the end of the bed when I knew mum - with mental capacity at that time was most likely listening. The primacy of person-centredness seemed to be by-passed. I suggested the doctor ask mum since once hydrated she would be fine. There has been a sense of a script being followed with some pressure - urgency behind it, if not a 'prescription'. I empathised with the doctors, often FY1 FY2; such matters are never easy. Now amid COVID-19 there is alarm as social care are challenged with taking on a new role, for which they are ill-equipped. 

In health care you are always conscious of the inverse care law, it seems there is another care law in operation that gives cause to worry for those who cannot advocate for themselves or have no independent advocate. Perhaps there is another inverse law that runs concurrently concerning ethics. Triage, is real. Objectively, as a nurse you think "Am I being selfish?". But, as eldest son - absolutely not. These conversations, and the future aside, the doctors and team as a whole have worked (absolute) wonders for which mum and the family will always be grateful.

Be Well, Be Safe All.

 

individual

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INTERPERSONAL : SCIENCES

humanistic ----------------------------------------------- mechanistic

SOCIOLOGY : POLITICAL

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group - population

"There should be no wrong door and every  service should reverse the ...	... Inverse Care Law, which simply states those people in need of health and social care the most  get them the least."
https://www.smithsltd.co.uk/doors/composite	By MrPanyGoff - Own work, CC BY-SA 3.0, https://commons.wikimedia.org/w/index.php?curid=19702555

A comment at The King’s Fund, by Lord Victor Adebowale.

Partnership Working, Time to Talk, Drink and Drugs News, October 2018, pp.10-11
https://drinkanddrugsnews.com/wp-content/uploads/2018/10/DDN-October-2018.pdf

If anyone has a photo of a red door at a care or nursing home that I can display above please let me know.

Stranger in a strange land: 'Adult' CMHT

I've started working in an 'adult' community mental health team. This is a change in character from older adults and in Hodges' model we can draw the discussion on this out in several directions.

The 'adult' - 'older adult' distinction on one hand may seem discriminatory. So, once you are aged 65 you move to another service? On the other hand there are many scholars / professionals who have over many decades fought to have older people's needs recognised, represented and funded as a distinct speciality. There are protocols accepted and practiced that should - must also take into account the patients (carers) wishes allied with needs and circumstances.

The 'character' is also different between adult - older adult, but both carry unique challenges*. This must always be the case if the patients and their situation are viewed as unique.

3.5 days in - I'm already aware of changes in community mental health provision. My previous experience 16-65 goes back to 1995, apart from having some patients during studies in psychosocial intervention in psychosis.

There seems to be more chronicity and I have a sense that suddenly 'nursing' has a welfare and benefits problem solving flavour to it.

The summit I've just posted about is invaluable learning, as I have inherited a caseload of people living with varying forms of diagnosed personality disorder. I'll expand on this experience over the next few weeks. This is timely as I have re-validation next year.

Over many years I have heard of Paris the clinical record system. Now I will be having training and become a 'user'. Looking forward ...

*With challenges also come rewards!

Healthy Active Ageing Virtual Global Discussion Forum: Int. Day of Older Persons 2010

Dear Colleagues,

The World Health Organization, Departments of Reproductive Health and Research, Human Resources for Health, University of Iowa Hartford Center of Geriatric Nursing Excellence, and Partners would like to invite you to join Healthy Active Ageing Virtual Global Discussion Forum - 1-12 October 2010.

Join us in creating an interprofessional network involving representatives from health professions, policy makers, programme managers, international organizations/agencies, universities, research institutes and our clients to share our knowledge and experience on issues that affect healthy ageing.

REGISTER NOW! http://knowledge-gateway.org/ahaa

Share your experience, your opinion on issues that affect us all, as individuals, families and health practitioners. Contribute through this forum to the policy and practice dialogue.

During this twelve day forum you will receive two emails per day; one email to introduce the day’s questions and one daily digest of the contributions. Daily questions will be disseminated within three topic areas:

• Challenges and opportunities to support healthy active ageing
• Sharing of success stories
• Caring for older persons with dementia

Once you have registered you can participate in the forum simply by responding to the daily emails or sending a message directly to ahaa at knowledge-gateway.org

You can also log into http://knowledge-gateway.org/ahaa to browse the archived discussions and resource materials.

For any questions on this Virtual Global Discussion Forum please contact the forum facilitator: 
Christina Fusco christyfusco at gmail.com

Please pass this invitation onto your colleagues and networks.

With kind regards,

Maggie Usher-Patel
Scientist/IBP Secretariat
WHO/RHR

My source: HIFA2015

Additional links:
Full of Life  - http://www.dwp.gov.uk/policy/ageing-society/full-of-life/
International Day of Older Persons - http://www.timeanddate.com/holidays/un/international-older-persons-day

Romeo and Juliet – the care home version

Octogenarian versions of Shakespeare's lovers to feature in Bristol production

Directed By Tom Morris

Fresh from co-directing the West End hit, War Horse, and Tom Stoppard and Andre Previn's orchestral experiment Every Good Boy Deserves Favour at the National Theatre, Tom Morris' own theatrical exploration of Bristol Old Vic begins with a project that has been twelve years in the making: Juliet and Her Romeo, the story of a flourishing love affair in one generation, crushed by the financial and political concerns of another.

Developed since 1997 in collaboration with Minder producer Sean O'Connor, the production uses Shakespeare's text, but casts our lovers in their 80s, with their anxious children, not their parents, seeking to prevent an imprudent and costly match.
With Sian Phillips as Juliet and Michael Byrne as Romeo, this production invites a generation of actors of global stature to play great Shakespearean roles which they never thought they'd play again. Tim Barlow, Terry Taplin and Michael Medwin return to Bristol Old Vic as Tybalt, Benvolio and Paris. Dudley Sutton makes his debut on the Bristol Old Vic stage as Mercutio.
What family has not wrestled with the question of how we care for our parents as they become older and frailer? Who will love them? Who will support them? Who will pay for their care?
And with that care, what controls should we apply? If we have taken power of attorney, what about the freedom to fall in love, to give gifts, to marry unwisely?
As Ben Power's recent two-handed exploration of passionate love remembered in old age demonstrated, Shakespeare's text is a powerful love story for any generation.
Signed, Captioned and Audio Described Performances.
Signed performance: Sat 10 April 2.30pm
Captioned performance: Sat 17 April 2.30pm
Audio described performance: Sat 24 April 2.30pm
Additional link:
BBC Culture Show