Care of a severely handicapped person over eight years: implications for the future pattern of community care.

This case report describes eight years practical experience of community support for a quadriplegic woman with progressive multiple sclerosis. Key factors in avoiding institutional care were the close collaboration between general practitioner, hospital consultant and social services, and the recognition by the doctors that the social dimension was the dominant requirement for support. Other important points were the identification of one key worker from the many professionals involved, and the use of separate NHS and social service funds to employ care attendants. This funding allowed community nurses to utilize their professional skills while the care attendants solved the problems of dependency. The mechanisms of community support for the individual are discussed in the light of proposed changes in the organization of care for the disabled.