Making it happen - What this means for Sarah

  • Jane took on a key-worker type role to co-ordinate making sure Sarah’s outcomes were achieved.
  • Sarah wanted to be supported by her daughter-in-law Catherine and to see as much of her grandchildren as she could. They decided to use her personal-budget to pay for childcare to enable Catherine to support her, instead of buying in support.
  • The Mental Health Team explored how to support Eric, as Sarah could no longer be his main carer.
  • Jane and Sarah developed her Advance Care Plan and this included contingency planning. Jane worked in partnership with her GP and made sure that there was a ‘just in case’ bag available. Jane, Catherine and Sarah talked about how she wanted to be remembered and decided on memory boxes and leaving letters for her grandchildren, as well as thinking about funeral arrangements. The contingency planning included what would happen if Catherine, as the carer, needed more support or respite, and what would be possible if Sarah was not able to stay at home (for example hospice day care, or overnight respite at the local hospice/Marie Curie nurse staying overnight) or bringing home to the hospital as much as possible (dog visiting, seeing home and family on skype or webcam).