Seddon Diane, Robinson Catherine
School of Social Sciences, Bangor University, Gwynedd, UK.
Health Soc Care Community. 2015 Jan;23(1):14-22. doi: 10.1111/hsc.12115. Epub 2014 Sep 22.
Since the early 1990s, UK social care policy has committed to supporting carers. Legislation (England and Wales) over this time period has recognised the importance of separate carer assessments that take into account an individual's ability and willingness to care. This paper considers carer assessment from the perspective of social care practitioners. It reports on qualitative data from a carer research programme that spans over 20 years (1993 to present) and includes 383 in-depth interviews with social care practitioners across England and Wales. Offering unique longitudinal insights, we identify some persistent tensions associated with the translation of UK carer assessment policy into social care practice. We explore practitioners' long-standing ambivalence towards carer assessment and their reluctance to evidence carer need via a separate assessment process. Deficits relating to the conduct of carer assessment are identified. For example, the reliance on structured, problem-focused assessment protocols that restrict discussions to the personal care aspects of caring and fail to capture the complex, diverse lives that carers lead. Carer assessments do not reflect the reciprocal nature of many caring relationships, as a one-way direction of care is assumed. They do not take into account the broader support network of individuals who may be involved in helping someone with complex care needs. Carer willingness to care continues to be taken for granted and planning for the future is a significant gap in carer assessment practice. The proposed changes to the social care systems across England and Wales provide a timely opportunity to review the process and conduct of carer assessment. Policy guidance needs to clarify the links between service user and carer assessments and the way these align within broader assessment and care management frameworks. Assessment tools that encourage a narrative approach to carer assessment and capture the affective aspects of care-giving could benefit future practice.
自20世纪90年代初以来，英国社会护理政策一直致力于支持护理者。在此期间（英格兰和威尔士）的立法已经认识到单独进行护理者评估的重要性，这种评估要考虑到个人的护理能力和意愿。本文从社会护理从业者的角度来探讨护理者评估。它报告了一项跨越20多年（1993年至今）的护理者研究项目的定性数据，该项目包括对英格兰和威尔士各地社会护理从业者的383次深入访谈。通过提供独特的纵向见解，我们识别出一些与将英国护理者评估政策转化为社会护理实践相关的持续存在的矛盾之处。我们探讨了从业者对护理者评估长期以来的矛盾态度，以及他们不愿通过单独的评估过程来证明护理者需求的情况。确定了与护理者评估实施相关的不足之处。例如，依赖结构化的、以问题为重点的评估方案，这些方案将讨论限制在护理的个人护理方面，未能涵盖护理者复杂多样的生活。护理者评估没有反映出许多护理关系的相互性质，因为假定护理是单向的。它们没有考虑到可能参与帮助有复杂护理需求者的个人的更广泛支持网络。护理者的护理意愿仍然被视为理所当然，而对未来的规划是护理者评估实践中的一个重大缺口。英格兰和威尔士社会护理系统拟议的变革为审查护理者评估的过程和实施提供了一个及时的机会。政策指导需要阐明服务使用者评估和护理者评估之间的联系，以及它们在更广泛的评估和护理管理框架内的协调方式。鼓励采用叙事方法进行护理者评估并捕捉护理情感方面的评估工具可能会有益于未来的实践。
