NURS 217 Health Assessment

Disabled people have a low social and economic participation rates, a high level of poverty, misuse, poor health and social isolation in one of Australia's most vulnerable communities. It is estimated that 18% of Australians have impairment, with about 6.7 percent having a serious or profound disability. The percentage of disabled persons is expected to gradually increase as persons with permanent disability live longer, survival rates of persons with adult disabilities increase and aging-related disablement increases. Disability is a broad concept that continues to overshadow the diversity of people that bear this classification in terms of the extent and seriousness of their illness (Hardy et.al, 2020). It covers individuals at all stages of life and affects many areas of life. Disabled people often belong to other groups characterized by sex, class, ethnicity, colour, sexuality and location which also exacerbate the disadvantage they face as disabled people.

Since the 1970s, an important paradigm change that differentiated disease and disability has resulted in a human or medical model replacing a social model of disability. However, paradigms coexist and change. Intellectual disability among older people is one such concern among Australia wherein people suffers from dementia, psychological issues, depression and other issues which make them unable to perform day to day activities and therefore they are either referred to social care workers within the residential aged care or seek treatment from the hospitals (Petersen et.al, 2014). Within this whole process, the social care worker plays an important role in management of intellectual disabilities of older age in residential care. In the following section, the discussion has been made in relation to the role of Social Workers in Australian Aged Care with respect to the people suffering from intellectual disabilities.

Social Workers

The social work profession works at the intersection of individuals and their social, educational, physical, as well as natural settings, while acknowledging the effect of psychological, social, political, and economic determinants on health as well as well-being. The social work profession is dedicated to improving the well-being of people as well as society in a whole. Person and community well-being, are supported by socially egalitarian societies that emphasize social justice values and regard for human dignity as well as rights, involving the right to be free from intimidation and the aspect of exclusion. The social workers are focusing on the interface among the person and the community and on the hypotheses of social, scientific, psychological, humane, and indigenous expertise and acknowledge the effect of social, cultural and economic influences on the health and well-being of individuals and societies.

As a result, social workers have a dual emphasis on assisting and strengthening human well-being, as well as solving any external problems (known as societal or structural issues) that could have an effect on well-being, like the racism, poverty, and segregation. Social work is a tertiary-level discipline that is recognized both nationally and globally. The Australian Association of Social Workers (AASW) is the basic professional body in Australia that represents social workers and is in charge of accrediting social work university programs. By seeking the requisite degree, they are eligible to act as social worker in the context of Australian Health Care system (Laragy & Allen, 2015).

Intellectual disabilities among adults

Improvements in medical diagnostics as well as eventual access to adequate care have dramatically increased a person's life expectancy. Individuals can live not only life but also chronological age even though they have a serious disability. Although there have been strong indications for the growing life span of people with intellectual disabilities over the last few decades, there are major challenges in providing care to this group of people in Australia and elsewhere.

In the field of health care, the aging of persons with intellectual disabilities is a relatively recent problem and thus the policy and funding system in Australia remains relatively irrelevant. There is a lack of awareness and government policies, particularly for aging intellectually disabled persons. There is a lack of information.  It is understood, however, that intellectually disabled individuals already face more health problems than ordinary people, that these current health conditions are often not adequately met and handled, and that aging then often comes with a further rise in care needs (Hughes et.al, 2016).

In addition, people with developmental disabilities face considerable inequalities in access to health care and resources long before secondary aging causes began to appear. A study commissioned by the Family and Community Services Department in New South Wales in 2011-2015 recommended major improvements to the care systems and homes for intellectual-disabled persons. The Commission found that the funds for the programs in question were not so flexible enough to satisfy aging requirements, with an increase of 47 percent in the total time required for the aid of an intellectually disabled individual reaching 60 years old.

It has found that the transport expenses of both general and specialty medical meetings are increasingly being paid as people with an intellectual disability age for the support of housing. There is no understanding of the way the aging procedure affects the carers, the families and the individual's peers while some work takes place especially for helping this community with its evolving welfare needs. Especially the physical, social as well as emotional problems facing families, co-residents and programs that help an individual with an intellectual disability are little understood.

Many aging individuals want to take care of their adult disabled children and be responsible for them even if they have a specialist lodging (Hughes, 2011). Families are experiencing emerging challenges such as the need to change their homes to sustain the ongoing life of the household, while disabled people are regularly surviving their parents. As such, the larger family member, relatives, and support providers must closely consider and prepare what is going to happen with the death or disability of either or both caring parents. Comprehensive family planning, though, is stated to be uncommon and a resilient aspect to the mechanism is involved (Kalliath et.al, 2012).

Role played by the social workers

Australian welfare professionals serve in a number of elderly people's support organizations. Social workers, for example, have been working for a long time in elderly care appraisal teams which evaluate elderly people and identify eligibility for government-supported elderly care services including home-based assistance and home-based treatment. Many social workers care with the elderly in non-aging contexts, which also includes the community as well as the mental-health care, disability services, home services, private practice, and the Australian Benefit-making Agencies. Social workers are both involved within government and outside government in policies, research, and lobbying positions relating to aging and related problems. While comparatively few social workers work in homes old, the many social workers in hospitals, unlike the United States, play an important role in facilitating access to emergency, transitional and long-term health services for older adults. The effects of demographic aging and the complexities of a change in the health and human care system underline the importance of social work for elderly people (Tyler, 2010).

Australia is projected to grow its population from 14% of the overall population in 2012 to 19.4% in 2030, and then to 24.5% in 2060. In Australia the population is prolific. This leads to a higher risk of health diseases associated with age, like dementia, diabetes and cardiovascular disease. A significant policy concerns are older addiction ratios, which will rise from 20 percent in 2007 and 42 percent in 2056 from the figure of 20 percent in 2007, compared with the workforce of those aged 15 to 64 years and older ("The definition and prevalence of intellectual disability in Australia, Summary - Australian Institute of Health and Welfare", 2021).

There is also question of the ability of the country to produce the wealth needed to support an increasingly elderly populace, even as there are gains from population aging, such as improved social as well as intellectual capital. This demographic imperative has led to national policies that decrease disease burdens at the end of life, raise the economic efficiency of the elderly and minimize public health and social spending (mainly pharmaceutical). Australia is now part-way in the introduction of an old-ages nursing improvement programme, with the intention of expanding this model to residential old-age care, by implementing consumer-led care (Heiman & Artiga, 2015).

The purpose of a social worker is to ensure that useful as well as adequate service services are put in force, committed and fully used in an effort to increase the health and ensuring well-being outcomes of older individuals. This involves helping elderly adults and their caregivers to make important lives dependent on knowledge and support from the best aging care accessible. Social services consult with the elderly person to guarantee that health and well-being results are obtained by working with and reviewing the efficacy of adequate service programs (formal and informal). The value of social service networks and the insulation faced by many elderly people was unique to social workers.  

The social workers advocate the rights of the elderly against inequality, decreased opportunities as well as elder violence through their commitments to respect for civil rights and social justice. Social workers are of the opinion that people should have stable, positive and active lives as a life stage of their older ages. Connection to and inclusion in the larger society is an essential component of this mechanism. Social workers play an important role in delivering adequate, tailored resources to address varied as well as multidimensional needs of older people through their emphasis on holistic attention, self-determination and the capacity to take on the complexities associated from an ethical, legal, psychosocial viewpoint. In a wide array of situations, social work for elderly adults involves and involves a variety of processes and techniques. The scope and role of the agency/organization in the field of a social worker is affected. Despite this wide range of expertise, social workers in this area use common skill sets independent of background (Taggart et.al, 2012).

Transition in care patterns

In the last 20 years, significant changes have taken place in approaches for the treatment of people with dementia and research has been conducted into how to improve the welfare of people with dementia. The "personhood" principle explains the promotion of a paradigm of individualized treatment that supports the appreciation, inclusion, independence and personal relationship of persons with dementia, in spite of a cognitive disability.  The implementation of person-centred care models can have important implications for the well-being of people with dementia in a long-term care context. However, it is difficult in the acute hospital environment to carry out personal care methods due to organizational restrictions.

While the uptick in aging world population is perceived to be one of contemporary medicine's success stories, an increase in life expectancy leads to a spike in age-related illness. People with dementia on average stay in hospital times as large as those with no dementia and get higher readmission rates over a period of three months. They mostly stay in acute, sub-acute, or temporary hospital beds before a place in a long-term care facility becomes open. By 2050 the condition is estimated to be one of the greatest problems facing health and social care services around the world and is expected to affect over 14% of Australia's population with dementia. Advocacy on behalf of and for persons with dementia is drawing ever growing emphasis on the unfair and dangerous character of gathering elderly, dividing them from them and confining them in nursing homes, expressly calling them apartheid (Heiman & Artiga, 2015).

Many individuals with dementia inevitably need treatment for the elderly, often followed by placement in hospital. Entry to a hospital for people with dementia is an exhausting physical and mental period and that 38% of people with dementia are reluctant to go to their home as compared with 2% of others. The change to caring for the elderly is a crucial moment for taking decisions and is often described as a time of turmoil for which many families are not ready. Because of the progression of the disease, the blame for preparing and handling treatment transfers often falls on family caregivers, many of whom experience elevated levels of remorse, depression, and a feeling of disappointment as they try to come to grips with no longer being able to take care for their family member.

This difficult period is intensified by a time-consuming quest for knowledge and support, locating and obtaining an appropriate residential care placement, and navigating a diverse aged-care environment including several providers. Some families seemed incapable of making a decision, as they had little ability to deal with the mental tiredness and fatigue associated with their caring job. Any families resisted the placement of their family members or retarded decision-making due to a feeling of duty to them, and then hurried decisions (Khaksar et.al, 2017).

The typical facilities offered during the care of the resident age are, in other words, "assistant work with day-to-day duties (for instance, washing, cooking, laundry),""personal care (for example, bathing, dressing, clothing, toilet treatment)." In general, assistance via the residential old-age care alternative includes the provider of old-age care hostels, so that individuals are fully dependent on all support and care in this one facility (including supports to facilitate access to the community). A medical model targeted to healthcare services basically supports the conventional model of treatment. This led to the construction of large-scale installations in the early years of the modern age of rooms leading to long, often intimidating halls, central dining areas, and restricted access to gardens or outside areas.

That also meant that the majority of bedrooms were shared, with most being twin sharing or four-bed wards as in hospitals. Although some of those facilities continue to exist, the changes of the 1980s, evolving user requirements and a more comprehensive definition of good dementia design standards contribute to awareness that delivery to the community will increase functioning, symptoms decrease as well as quality of life for people with dementia (Fitzpatrick  & Grace, 2019). Particular care units have also been established such that person centred care can be provided. However, an understanding of the rights of the dementia patient was not adequately consulted by the establishment of an understanding of good design for dementia patients. As a result, while visiting an Australian residential aged care home, one is likely to find two key built-environmental elements that are almost universal (Aasw, 2021).

Major governing aspects

Without assistance, older people seeking aged care services who have intellectual, emotional, physical, or mental disabilities might find it difficult to exercise their rights to health care, an acceptable quality of living, and social security. In the light of Australia's aging population, aged care is becoming an increasingly significant area of federal responsibility. Under the Aged Care Act and the Home and Community Care scheme, the Australian Government oversees institutional aged care and home care. The Australian Aged Care Quality Agency is responsible for the monitoring, accreditation, as well as quality assurance of Commonwealth-subsidised residential aged care agencies, as well as the monitoring of the quality of home and community aged care facilities, under the Australian Aged Care Quality Agency Act 2013 (Cth). The decision-making model of Commonwealth leads to demands for simple, nationwide guidelines for CRPD-compliant decision-making in aged care.

The model will recognize advocates who assist aged care consumers in making decisions, as well as legislators who make decisions based on the will, interests, and rights of aged care consumers. The updated Quality of Care Principles 2014 (Cth) outline approved providers' obligations when delivering residential and home care facilities. These standards also describe the term "representative" of a care client more explicitly than the Act does. These are some of the legislative governing aspects in relation to the regulation of residential aged care among the elderly with the help of social workers. Apart from it, the basic human rights also protect the individuals in regard to seeking quality care for the aged patients.

The international approach to care homes under human rights law allows for the problem-solving separation of dementia living persons — through the aging care system — and for the development of the society into the foundation of housing, support and care on the basis of values of dignity, integration and justice. That the emphasise the importance peak bodies, including National Disability Services (NDS), Leading Age Services Australia (LASA), as well as Aged & Community Services Australia (ASCA), creation of  a collaborative training agenda addressing common educational needs for people aged with an intellectual disability is important ("Aged care | ALRC", 2021). During the course of their respective training hours, aged care and disability support providers that are based nearby in remote areas work in collaboration to provide community outreach programmes.

Scope and contribution of social worker and practice

While working in the aged care sector, social workers use a variety of biological, life course, psychological, as well as social theories to shape evaluations and strategies, as well as to analyze their practice. Social work evaluations vary from tailored as well as brief specific-needs reviews to detailed holistic psychosocial and the inclusion of the risk assessments of a wide range of social and psychological needs, abilities, and stressors, as well as assessments of family interactions and situations. These evaluations serve as the foundation for tailored and needs-based approaches to solve the psychological and mental problems affecting an individual's health and well-being.

The approach to appraisal of a social worker is informed by the application of particular hypotheses which is dependent on their own clinical qualifications and practice. While the elderly are the main concern of social workers, they also deal with families, parents, husbands, daughters, siblings, grandchildren, and caregivers. Social work tests and strategies support not only the client, but also the decision-making abilities of other experts. As a result, social workers are often included in multidisciplinary care teams, specifically where approaches are influenced by diverse social, psychological, personal, and institutional complexities. These basically include the aspects of assessment, capacity building, counselling as well as use of therapeutic approaches, planning, mediation or resolution of conflicts, case management and service coordination, advocacy, policy design and program and other significant aspects (Aasw, 2021).

Social workers have a unique contribution by providing effective as well as targeted resources to address the whole-of-life needs of persons with disabilities, with an emphasis on comprehensive care and also providing the opportunity to understand the complexities involved from various viewpoints. This multifaceted approach provides understanding of human functioning and behaviour, as well as how financial, legal, and cultural considerations intersect and affect the stigma, inequality, marginalization, and social alienation that many people with disabilities and their families face. Within a system of client empowerment, social workers conduct evidence-based evaluations, preparation, and strategies.

Social work approaches consider the impact of an individual's health, psychosocial, or other needs, as well as their support mechanisms. Social workers are often active in multidisciplinary teams, particularly where activities take place in the context of diverse social, psychological, family, and structural contexts. In this regard, social workers will help other practitioners and the multidisciplinary team make better decisions. Over all, social workers value the primacy of human rights and aim to empower individuals with disabilities to choose how they live their lives (Aasw, 2021).

Conclusion

To conclude, with their education and expertise, social workers are ideally adapted to dealing with an elderly person within their family as well as from social background, especially in terms of mediating tensions and disputes that may occur. The aim of social work for older people is to maintain and/or improve functioning and effective quality of life. Social workers address the multidimensional needs of elderly adults and their families, with an emphasis on holistic treatment and the opportunity to understand the complexities inherent from different perspectives. Professional social workers have plenty to offer the disabilities field in both government and non-government organizations, as well as the developing private sector. Social workers, with an emphasis on self-determination and holistic interpretation, have a specific and important contribution to delivering effective as well as provision of tailored care to address the diverse needs of people, their families, and populations in both disabilities and conventional services.

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