Personal health budget care planning and support
Having worked as a Continuing Health Care Nurse Assessor in previous years I was interested to learn how Personal Health Budgets worked, how they were administered and most importantly the potential benefits to the person. Historically, when people were awarded Continuing Health Care funding there was not much choice in how their ongoing care was organised and it seemed very prescriptive.
I joined the Partner2Care (P2C) team 2 years ago as a Nurse Assessor for Personal Health Budgets. I was tasked with assessing and formulating a care plan for Olive. Supported by a Brokerage officer who manages the recruitment and payroll services I completed the care plan and subsequently submitted it to the CCG (Clinical Commissioning Group) for budget approval.
I noted that that the assessment centered more on the person’s wishes and needs rather than their diagnosis and medical history.
Olive’s Story
Olive has Huntington’s chorea. She was placed under a section 2 order and admitted to a secure unit due to her increased behavioural problems, violence towards others and lack of compliance with prescribed care. Post discharge, Olive went into a care facility, which according to her daughters, did not meet her needs and was not a good experience. There were issues around Olive’s safety and wellbeing for which the daughters raised a safeguarding concern. It was decided to bring her home and have agency care. According to her daughters, her behaviour improved significantly over the 3 months since her return home. However, issues remained and her daughters and partner agreed to take over the caring role themselves as they considered that they knew her better than anyone else. They applied for a Personal Health Budget and once this was agreed they became the carers for Olive.
As her carers who knew and understand her well, they were able to anticipate Olive’s needs at all times as she was unpredictable in what she wanted and what she wanted to do at any given time. Everything about her throughout the day and night was unpredictable, nothing followed a pattern.
Olive lived with her partner but he was still working so could only offer minimal support in the evenings. They did however; still enjoy being a couple and Olive was contented in the evenings, sitting and watching television for the most part.
It was noted that as Olive was still mobile she could be very restless and moved around a lot from one place to another with a high risk of falling. Her independence remained important to Olive who liked to decide when she had a wash, when she wanted to eat and she also liked going to bed at different times of the day. As part of the assessment, it was identified that Olive’s needs had increased and that she required more help and constant supervision by those who had a good understanding of her condition in order to keep her safe and free from harm.
She enjoyed playing Snakes and Ladders and generally liked to be kept stimulated and not left without anything to do. She also enjoyed going out for trips in the car. These activities kept Olive engaged and busy.
The care plan was written in conjunction with her daughters (who had lasting Power of Attorney) and included details of current limitations to her lifestyle, caused by the impact of her health condition. Most importantly, it set out what and what was important to Olive to enable her to ‘live her best life’. When the first draft was completed and approved by her family, it was submitted to the CCG for approval. The proposal was that both daughters and a granddaughter would become 24hr live-in carers on a rolling basis. Her partner would remain her partner. The care plan was ultimately signed off and it was agreed that her 2 daughters and a granddaughter could become Personal Assistants for Olive. It was what they deemed most appropriate for Olive it and also satisfied a promise to her that they would look after her for as long as it was practicable and safe.
So what have I learnt?
Personal Health Budgets (PHB) affords people with long-term conditions and disabilities greater choice, flexibility and control over the healthcare and support they receive.
Having a PHB makes it a better experience for that person, improving their quality of life and helping them to achieve their chosen health and wellbeing outcomes. A lot of the behaviours that Olive presented with would not have been compatible with agency care schedules. Her daughters knew their mother and what made her happy so they incorporated the things that she liked into her daily routine such as listening to music, especially ABBA, and watching TV albeit she had a short attention span. She really enjoyed the company of her two very loving daughters who only wanted the best for her. Not only was she being stimulated and enjoying herself, her daughters had some of their ‘old’ mum back for some of the time and her partner also had time to spend with her when he was able. The care package ultimately afforded the family and her partner more time with Olive and made for a happy, safe environment for Olive to continue living in.
I get a great sense of satisfaction working with people to set up their Personal Health Budgets and oversee the ongoing case management alongside the Brokerage and Support Officers who have a wealth of knowledge around employment law, recruitment and payroll.