ABI Case Study A
Client A is 26 year old male who suffered a severe closed brain injury when he was only 3 years old. This resulted in a right sided hemiplegia and considerable cognitive difficulties affecting his memory, executive function and insight. He therefore has limited functional dexterity of his right arm and hand and has subsequently developed the use of his left hand and manages most tasks with this side. His right lower limb is also affected and walks with a hemiplegic gait, suffering pain and discomfort if he walks long distances or too fast. He has considerable problems with his memory and resultant difficulties with executive functions; such as planning, problem solving, multi tasking. He has no communication or behavioural problems but was socially isolated and lacking in self esteem.
Following initial assessment, Active Assistance agreed to provide a support package of 30 hours per week. A team of support workers with a recognised leader were recruited and weekly team meetings with our client present and the case manager were held to monitor and develop the package. An individualised, focused and agreed care plan was devised and introduced with clear care objectives and tools for evaluation.
The main identified areas where care and support was required were with his domestic skills such as housework and the need to promote the preparation of nutritious meals and assistance to shop and budget effectively. With his memory problems and it is helpful to write information down for him rather than expecting him to remember things and to encourage him to use calendars/diary/ white boards etc. It is important to help him break down planned activities into stages so he knows what to do and when to do it. Client A has difficulties with problem solving, organisational skills and with processing multi stage verbal and written instructions.
He is supported to develop social activities to promote inclusion and self confidence. He is very interested in music and was supported by his PA in approaching Scope, in Plymouth. A was successful in being given an opportunity to attend for a given period with his PA. He is now able to use his music skills in supporting others, and is met by his PA after each session. He has joined a gym and attends regularly with his support worker. Client A has experienced bowls, attended music festivals the cinema and has been paint balling, tree surfing and Go-Karting. He states he enjoys anything that gives him an adrenalin rush! A support worker is now funded to enable him to experience evening activities such as visiting pubs or clubs, which has been very beneficial for him. This has been an excellent confidence building exercise, and provided greater inclusion into the community. Agreed guidelines were drawn up and implemented to facilitate contact visits with his formerly estranged daughter, and these have been successful.
The package continues to go evolve with client A, his mother feels that he is far more vocal about his own wishes and has more confidence. The case manager has stated that he has a very committed team, who go to great lengths to support him in trying to improve his quality of life. The package is to continue with ongoing periodic review. As goals are attained, new ones are devised, to ensure he is supported to continue to achieve and grow as a member of society. It is hoped in the fullness of time with his ongoing progress, he will be awarded through the courts, increased hours per week to spend with his daughter.
ABI Case Study B
Client K is a 68 year old male who suffers from Progressive Supral Nuclear Palsy (PSP) who was originally placed in a nursing home. Continuing Health Care funding had been agreed and the plan was to discharge into the community. Active Assistance was chosen over other agencies by the family on the basis of references, and the training programme.
We built a team of staff to work day and waking night shifts. It became apparent very quickly that K didn’t respond to male staff so we employed female staff. The family met all of the staff prior to us employment. The family were very pleased with this process as they would be having staff in their own home for 24 hours a day.
We worked closely with the Community Matron, Nursing Home, District Nurses and the PSP specialist nurse start the care package. Due to K’s challenging behaviour it was important that all of the staff had been trained in positive behaviour management. K’s wife agreed that she would guide and train the staff in her own home as she understood K’s condition better than anyone. This worked well and the staff quickly built a trust with the wife and felt comfortable in their new working environment. K required help with personal care and he could never be left alone as his condition caused him to fall backwards, he had very poor sight and would walk into things so needed guidance at all times. The waking night was difficult as the staff sat in K’s room and watched him at all times, if they needed to have a break there was a vibrating monitor available that would alert the staff if K moved.
K settled very well initially and the staff team worked very well with him, they were supported by regular phone calls and visits from the Care Service Manager. It soon became apparent that K’s wife was struggling to cope with her husband’s challenging behaviour and at times she became very tearful so the staff supported her as well as K. An electric wheelchair was purchased by the family so that the staff were able to take K on trips out with his wife which he really enjoyed. As there was likely to be no improvement to K’s condition it was important for the staff to give him as good a quality of life as possible.
The team continued to support K’s evolving needs. Sadly, after a period of time his condition deteriorated to such a point that he had to admitted and it was felt he could no longer be supported in the community. Active staff worked with the family, K and other stakeholders to make this as easy as possible and supported the family through this difficult regression. Active staff spent 4 weeks training K’s new team in a specialist home before saying goodbye to him and his family.
Not all clients discharged to the community can stay there permanently as sadly individuals’ conditions can deteriorate. T case is an example of this.
However, K’s family did not forget us or the care and support we provided. Extracts from a letter sent by K’s daughter:
“You amazing people came into our life. My mum understandably wanted dad at home so that she could take care of him but this was not possible without support. The professionals involved worked extremely hard for us and with the continuing care that was allocated we decided as a family that there may be a way that we could take care of dad at home. We met with the lovely Angela the (CSM) and instantly felt such a warm sense of dedication on her part. After a few weeks we had dad at home with 24hr 1:1 care. We as a family were able to meet every carer who wanted to be part of the team and that is exactly what we were a team. There wasn’t a single carer who wasn’t completely dedicated and the care they delivered to both mum and dad was second to none.
Angela support was absolutely amazing even to the extent that she herself would come to the family home and support if things were difficult. We managed to keep dad at home for eight weeks and although this doesn’t sound like a long time it helped mum to cope with the terrible situation and she felt that she had tried her best to keep dad at home. He constantly kept asking to go home and we soon realised that he didn’t really know where home was anymore. One evening two weeks ago dad had a particularly aggressive outburst and although he didn’t mean too he hurt the carer that was taking care of him. Now in this situation you would expect the carers to be withdrawn, however Angela was adamant that this was not going happen and once again pulled out all the stops to ensure the best care for dad. The team stayed in place and whilst dad went back into the care home they continued to go in and care for him 1:1.
There simply seems to be nothing that is too much trouble for this company and whilst our situation is a very sad one we had the chance to meet and become very close to the ladies that have cared for dad. if you are looking for quality and specialist care then look no further.
I would like to take this opportunity to thank everyone involved with us as a family and our loss is most definitely somebody else’s gain.
Many thanks and big love to Angela and her stunning team you do an amazing job”