Initial Assessment Visit — Transcript

Recording: Initial care needs assessment, home visit Present: Karen Doyle (Field Care Supervisor), Arthur Bennett (client), Susan Clarke (client's daughter) Date of visit: 14 July 2026, 10:30 am

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Karen (Field Care Supervisor): Right, that's the recorder going. Good morning! So just for the tape, my name is Karen Doyle, I'm a field care supervisor, and I'm here today to do an initial assessment so we can put a care plan together. Can I start by asking you to confirm your full name for me?

Arthur: Arthur James Bennett.

Karen: Lovely. And your date of birth, Arthur?

Arthur: Third of March, 1947. So I'm 79 now. 80 next spring, don't remind me.

Karen: You don't look a day over 60. And we're here at your home — can you confirm the address for me?

Arthur: Yes, 17 Elmfield Avenue, Bath, BA2 6JP.

Karen: Thank you. And the best phone number for you?

Arthur: The house phone is the one I answer. 01225 448 392. I've got a mobile, but I never hear the blessed thing.

Karen: House phone it is. Susan, do we have Arthur's NHS number to hand? It should be on one of his prescriptions.

Susan: Yes, hold on... here it is on the repeat slip — 485 777 3456.

Karen: Perfect, 485 777 3456. Now, Arthur, do you live here on your own?

Arthur: Yes, on my own. Since Joan went into the nursing home two years back. It's just me and the radio.

Karen: Okay. And when our carers come to visit, how will they get in? Do you get to the door alright?

Susan: We had a key safe fitted by the front porch last month, Dad, remember? It's the little black box to the right of the front door. The code is 4-7-1-0. Dad usually hears the bell, but mornings he might still be in bed, so the carers should just use the key safe and call out when they come in.

Karen: That's really helpful — key safe to the right of the front door, code 4710, carers to let themselves in and announce themselves. Now, Susan, am I right that you're the main contact — next of kin?

Susan: Yes, that's me. Susan Clarke, I'm Arthur's daughter. My mobile is 07811 293 456. I live over in Keynsham, so about twenty minutes away.

Karen: Great. And who's your GP, Arthur?

Arthur: Dr. Priya Nair. She's very good. It's the Oldfield Park Surgery.

Susan: The surgery number is 01225 831 900.

Karen: Got it — Dr. Priya Nair at Oldfield Park Surgery, 01225 831 900. Now let's talk about your health. What conditions are you managing at the moment?

Arthur: Well, where do I start? The heart — I've got atrial fibrillation, they call it. Irregular heartbeat. And the COPD, that's the breathing. I was a smoker for forty years, gave up too late. And the doctor says I've got high blood pressure on top of that.

Susan: And the osteoarthritis, Dad — his right hip is quite bad now, it's what's really slowed him down. And he had a TIA — a mini-stroke — back in November last year. That's actually what started all this. He was in the RUH for four days.

Karen: Okay, so atrial fibrillation, COPD, hypertension, osteoarthritis in the right hip, and a TIA in November 2025. Any allergies I should know about? Medication, food, anything?

Arthur: Penicillin. Brings me out in a terrible rash, always has.

Susan: And he says he's allergic to sticking plasters but really his skin just tears easily — the district nurse said to note he has fragile skin and to use the soft dressings, the silicone ones.

Karen: Very useful — penicillin allergy, and sensitivity to standard adhesive dressings, fragile skin. Now, medication. What are you taking, Arthur?

Susan: I'll do this one, Dad. So he's on apixaban, 5 milligrams twice a day — that's the blood thinner for the AF. Bisoprolol 2.5 milligrams once in the morning. Ramipril 5 milligrams in the morning for blood pressure. He's got two inhalers for the COPD — the Fostair one, two puffs morning and night, and a blue salbutamol one as and when he needs it. And paracetamol for the hip, up to four times a day, but he forgets the lunchtime ones.

Karen: And how does he manage taking them? Does he sort them himself?

Susan: The pharmacy does a blister pack now — a weekly one, delivered every Monday. But honestly, if no one reminds him, he misses the evening lot completely. He doesn't need anyone to actually put them in his mouth, he just needs someone to open the pack with him and make sure he's taken the right section. His hands are a bit stiff for the packaging too.

Karen: Okay, so carers to assist from the blister pack at each visit — open it, check the right day and time slot's been taken. Not just a prompt, a proper assist. Now, mobility, Arthur. How are you getting about?

Arthur: Slowly! I've got the frame — the one with the wheels — for indoors. I can get from here to the kitchen and to the bathroom alright, but the hip complains. Stairs are beyond me now, so I sleep downstairs — Susan set the back room up as a bedroom.

Susan: He can stand up from his chair on his own if it's his high chair, but the low sofa he gets stuck on. Getting off the bed he manages, but he's slow and unsteady first thing. And he's had two falls this year — one in February in the kitchen, and one in May in the garden. Neither was serious, thank God, but the second time he couldn't get up on his own and was on the ground nearly an hour before the neighbour heard him.

Karen: That's important. So — mobilises indoors with a wheeled frame, lives on one level now, independent transfers from high chair but struggles from low furniture, slow and unsteady in the mornings, no stairs. Two falls this year, one long lie. I'm going to record him as high falls risk, given the history and the blood thinner. Now, personal care. What do you need a hand with, Arthur? Washing, dressing, that sort of thing?

Arthur: I can wash my face and top half at the sink alright. But I haven't had a proper shower in... well, I don't trust myself in there alone, truth be told. And socks and shoes are the enemy — I can't get down to my feet. Buttons take me all morning with these fingers.

Susan: So he needs someone with him for a shower — standby really, and help washing his lower half and his back. Help with dressing his bottom half, socks, shoes, and buttons. He shaves himself with the electric razor, that's fine. Oh, and he needs reminding to clean his teeth, or it doesn't happen.

Karen: Understood. And toileting — any issues there? I have to ask, I'm afraid.

Arthur: [laughs] Ask away, everyone else does. I get there myself, mostly. But I don't always... get there in time, especially at night. Susan got me those pads, the washable ones and the other ones.

Susan: He uses continence pads day and night now. He manages changing them himself mostly but the carers should check, discreetly, and there's a bin arrangement in the bathroom. No catheter or anything like that.

Karen: Okay — continent but uses pads, occasional urgency especially overnight, manages mostly independently but carers to check supplies and support discreetly. Now, food and drink. How are you eating, Arthur?

Arthur: Susan brings meals at the weekend and I do toast. I'll be honest, I've lost my appetite since Joan went. The doctor weighed me and tutted.

Susan: He's lost about six kilos in a year. The GP wants him on the fortified diet — full-fat milk, the build-up shakes, one a day. No swallowing problems, thankfully — normal diet, no texture changes. But someone needs to actually make the meal and sit with him, or he has two bites and leaves it. And he doesn't drink enough — he'll have tea if you make it, but he won't get up and make it himself, so he gets dehydrated. There's a jug system the district nurse suggested — fill a jug in the morning and it should be empty by night.

Karen: Very clear — normal texture diet, poor appetite, weight loss, one fortified shake daily, carers to prepare meals, encourage eating, and push fluids using the jug. Now, skin. You mentioned fragile skin — any pressure sores, any broken areas?

Susan: No pressure sores, but the district nurse said his heels and his bottom are "at risk" because he sits so much. He's got a pressure cushion for the armchair. And his lower legs get very dry and flaky — there's a cream, Diprobase, that's supposed to go on his legs every morning. Carers should keep an eye and report any red areas straight away, with him being on the blood thinner he bruises like a peach.

Karen: Noted — skin intact, at-risk heels and sacrum, pressure cushion in use, daily Diprobase to lower legs, carers to check and report any redness or bruising. Now, hearing and sight, communication. You said you don't hear the mobile —

Arthur: Deaf as a post in the left ear. The right one's not bad if you're facing me and you don't mumble. I've got a hearing aid for the left but the batteries are always dead.

Susan: Carers should stand on his right side and speak clearly, face-on. His sight's alright with his glasses — he reads the paper with them. English speaking, no other languages. He's sharp with his words, no problems making himself understood.

Karen: Good. And memory, mood? How would you say things are up top, Arthur?

Arthur: I forget things. Names, mostly, and whether I've taken the pills, which I gather you know about. But I know where I am and who's Prime Minister, more's the pity.

Susan: The memory clinic saw him in April — they said mild cognitive impairment, no dementia diagnosis. He repeats himself a bit and forgets appointments, so everything needs writing on the whiteboard in the kitchen. Mood-wise... he's lonely. He's down about Mum. He wouldn't say depressed, but he's flat. The GP knows, they're keeping an eye rather than medicating.

Karen: Thank you, that's honest and it helps. Mild cognitive impairment per the memory clinic in April 2026, oriented, repeats himself, needs the whiteboard for appointments. Low mood and loneliness, monitored by GP, no diagnosis of depression. Now the nicer bit — Arthur, tell me about your routine. What do you like? What matters?

Arthur: I'm up by half eight, breakfast is porridge, not toast, whatever I said earlier — porridge in winter, Weetabix in summer. Radio 4 in the morning, always. I like the cricket on long wave in summer. Cup of tea — strong, two sugars, and don't drown it in milk. I do the crossword. And Wednesdays Susan takes me to see Joan at the home, that's the fixture of the week, that is.

Susan: He hates being rushed, that's the big one. He'd rather the carer was ten minutes late than hurrying him. And he likes a chat — the company is half the point.

Karen: Wonderful. Now let me have a quick look around with you both... [pause] ...so for the notes: the back door step is loose — that wants fixing. There's a rug in the hallway that's a trip hazard, I'd recommend removing it. The bathroom has a grab rail by the toilet, but there's nothing in the shower — I'll refer to occupational therapy for a shower rail and a shower seat. Lighting in the hall is poor, one bulb out. Smoke alarms — I can see one in the hall, and it's working, tested it. The kitchen's fine. Equipment-wise you've got the wheeled zimmer frame, the pressure cushion, the high-seat chair, the hospital-style bed in the back room the district nurses arranged, and Susan mentioned the pendant alarm?

Susan: Yes, he's got the lifeline pendant, he wears it most of the time. That came after the May fall.

Karen: Good. Any concerns about anyone taking advantage, any worries about safety with money, anyone coming to the house who shouldn't?

Susan: No, nothing like that. The only thing — after the fall in May there was that hour on the ground, so our worry is really him being alone if something happens. No safeguarding worries about people, no.

Karen: So no current safeguarding concerns, main risk is falls when alone, mitigated by the pendant and regular visits. Right, let's talk about the visits themselves. Based on everything today, I'm going to recommend two visits a day, seven days a week. A morning call, 45 minutes, between 8:30 and 9:15 — that would be washing or showering, dressing, the leg cream, breakfast — porridge, Arthur — the morning medication from the blister pack, and filling the fluids jug. Then a teatime call, 30 minutes, around 5 o'clock — main meal preparation, the fortified shake, evening medication, a general check, and getting things ready for the night. How does that sound?

Arthur: Twice a day... I suppose. As long as they don't rush me. And they can talk cricket.

Susan: That sounds right to me. Honestly, that's the gap — mornings and teatime.

Karen: And in terms of what we're working toward — the goals I'll write down: keep Arthur living safely at home, which is what you want, isn't it Arthur?

Arthur: It's the only thing I want. I'm not going anywhere.

Karen: Keep him safe at home, reduce the falls risk, get his weight back up and stop the dehydration, make sure the medication is actually taken, and improve his mood with some regular company — and I'll put the Wednesday visits to Joan in as a priority to protect. I'd also like OT out for the shower adaptations, as I said. Now, Arthur — this care plan. Are you happy for us to put this in place? Do you agree to what we've discussed? You understand what we're setting up?

Arthur: Yes, I understand it all and I'll have it, thank you. Beggars can't be choosers, and you seem a decent sort.

Karen: [laughs] I'll take that. So recording that Arthur has capacity to consent and consents to the care plan himself. Susan, we've got you down as next of kin and day-to-day contact. In terms of dates — I'd like the first visit to be Monday coming, so the care plan starts on the 20th of July 2026. And we'll do the first review at six weeks, so let's say the 31st of August 2026 — I'll come back out myself and we'll see what's working.

Susan: That all sounds really good. Thank you, Karen.

Karen: Lovely. So, completed by me — Karen Doyle, Field Care Supervisor — assessment done today, 14th of July. Arthur, thank you for having me, and I'm going to stop the recording now.

Arthur: Put the kettle on then, Susan.

[Recording ends]