This essay is about evaluating a care package for an 82 year old man with Parkinsons disease who has been admitted to hospital with a chest infection. In order to evaluate the care packagre there needs to be an understanding of Parkinsons disease is and how it effect people. I am alos going to discuss what the Clark family could have in their care package and how this adheres to government and hospital policies. I will also discuss a small amount about benefits that may help with paying for the care needed.
Parkinsons disease is a disorder of the central nervous system producing symptoms which affect movement and speech. It is a degenerative condition that affects the basal ganglia (nerve cell clusters) in the brain. This group of cells is thought to influence the initiation planning and execution of movements, normal functioning being dependant on the equal presence of two chemical neurotransmitters dopamine and acetylcholine. When these are not balanced it causes movements to become increasanly slow and clumsy. The person knows what they want to do but the muscles will not respond to their wishes. It is not known why these nerve cells fail to function normally.
Parkinsons disease produces these main symptoms – tremor, stiffness of the muscle (rigidty) and slowness of movement ( bradykinesia) with difficulty in initiating movement. Although tremor is thought to be a symptom all parkinsons patients suffer fform this is untrue as a sizeable proportion do not have a tremor. There is no cure for Parkinsons disease, management of the condition is by individual drug regime. This will hopefull reduce the disabling affects of the disease.
Mr clark’s care package is not suitable for his needs, there is not enough input and support for him or his wife. Mr clark is not an ideal patient as he does not understand why he needs any extra help as he relies heavily on his wife, she is not coping with him now. Mr Clarks daughter can not help as she has to help her own daughter during her health problem. Mrs Clark is currently the main carer at the moment except the carer who comes in the morning who washes and dresses him and puts him downstairs for the day.
This is not enough care as there is no one coming in the evening to help put him to bed and settle him for the evening so this needs to be changed his drug regime may have to be changed so that he is mobile when the carer come in. I think that it might be advisable to look at getting a special air mattress for him to prevent pressure sores as Parkinsons patients find it difficult to turn over in bed at night.
Mr Clark is not very mobile so the chair that he sit in all day needs to be raised so that it is not so difficult for him to get up, also pillows would help to ease some of the pressure. There is also an issue about moving and handling Mrs Clarke should not be transferring as she is very fragile herself and this would have to be looked at as there is some issues. Mr clark has had some alterations to the home such as a grab bar and stair lift. Mr Clarke needs the armchair that he sits in during the day raised as it is to low at the moment which would make it easier for Mr Clarke to get out of himself.
Mr clarke needs to be aware that he needs to comply with his drug therapy otherwise he may be liable to get other infections that could mean being admitted to the hospital. Whilst Mr Clarke has been in hospital his Parkinsons drug regime has been well managed as there has been nursing staff to give his medication at appropriate times. This needs to be continued on discharge otherwise his Parkinsons will deterioate again. Although this does seem unlikely as before admission Mr Clarke did not comply with his drug regime due to some of the side affects of the drugs. There is no mention in the care package about referring him to the Parkinsons nurse or that he has already been referred.
I think that Mr Clarke needs to be referred to the Parkinsons nurse if there is one at the nearest hospital as he could discuss with him/her about the side affects from the drugs and perhaps do something to prevent these. This would be ideal for the Clarkes as they do not have anyway of getting to the hospital, but most Parkinsons nurses can visit them in their own home. There is also an oppurtunity for the Clarkes to go to a Parkinsons support group which enables them to talk to fellow sufferers and for carers to talk to other carers as he carers normally are their spouses. I feel that Mr and Mrs Clarke would benefit from this especially AS Mrs Clarke is feeling isolated not being able to see her friends from church anymore so this could help her.
There is continuation of rehabilitation as Mr Clarke has been added onto the waiting list for domicillary physiotherapy, but whilst waiting for that have arranged physiotherapy at the day hospital 2 days per week. Although this could prove difficult as they can not get there but transport can be arranged either by voluntary care service or an ambulance from the hospital. Mr Clarke has been discriminated against with regards to physiotherapy as priority has been given to stroke patients, he has been dicriminated against because of his condition. This could be seen as unethical as everyone has the same rights and perhaps the word priority should be changed to the greater need. Everyone should have equal prority and equal access to services, this would show an inequity in services.
After the multi-disciplinary team meeting and conference it was decided that they would review and assess the social care 3 weeks from discharge, I feel the assessment should be sooner as we need to know how they are coping as soon as possible as we do not want Mr Clarke to end back up in hospital which could happen if not given the correct support. It is also better to do the assessment earlier to see how Mrs Clarke is coping as if she was not then Social services could step in sooner and Mrs Clark’s health would not be detremented in anyway. The occupational therapist are going to reassess 2 days after discharge, I think this wrong as I believe that Mr Clarke should have been taken on a home visit as how can they assess how much the chair needs to be raised without the patient there. It would have also been good to assess Mr Clarke using his frame in his own environment and using the stairlift to assess whether it is safe.
I recommend that Mrs Clarke would benefit from a carers assessment which comes from the Carers(Recognition and services) Act 1995 this looks at whether a carer provide for the relevant person so in this case Mrs Clarke for Mr Clarke. They would assess Mrs Clarke to see if she could with cope with caring for Mr Clarke and meeting his needs, so if after assessing Mrs Clarke it may be that a greater input is needed.