Meet Jim - an elderly person with complex health and social care needs

Jim is 80 years old and was previously married to Mary, who died nine months ago. He has two daughters who are both married and live a few counties away and they have three children between them.

Although now retired, Jim used to work as a fitter in a local engineering firm. When he was younger he loved bikes, DIY and family trips. He is a member of the local church, having once been a lay preacher.

He was admitted to hospital with a stroke four weeks ago.

In the following case study, we describe two scenarios for personal care and support planning for Jim. The first assumes a lead role for the GP in supporting Jim through personal care and support planning, while the second describes the process where the social worker plays the lead role.

Both of these scenarios are plausible and viable for Jim and help to demonstrate the flexibility of roles and approach advocated in this resource.