Determine personal support requirements

In Australia, health and community care service structures differ according to the amount of funding, legislation, operational requirements, and governance. They can be cooperative, hierarchical, private, sole or a contractor. Funding can be state or federal through a grant, charity, private or corporate.

Types of care and support can be provided through different services such as:

• home care
• community care
• residential
• palliative care
• health care
• government funding.

Some examples of support services are:

Examples of Agencies in the Aged Care Sector include:

Aged Care in Australia is overseen by important government departments and services. Services are regularly assessed to make sure that they are following legislation and standards. You can talk to the people you support and their families about how these services can help.

The following table shows some examples of agencies within this sector:

Activity

Consider your local area. What services are available for older people? Research one service on the internet. Have a look at the About Us page. What type of organisational structure does it have? Is it private or public? Provide an overview of the services they offer. What funding is available?

Rights and Responsibilities

Employers, workers, and clients all have particular rights and responsibilities in the workplace. In the areas of diversity relating to culture, age, disability, sexuality, and gender, many different rights and responsibilities apply. For example, an employer is responsible for providing a non-discriminatory workplace, and a community services worker has a right to be treated with dignity and respect during a home visit.

The following provides examples of clients, employees and, employer rights and responsibilities.

CLIENT

Rights

• to be treated with respect
• to be informed and to give your views.
• to be part of decisions about your care
• to receive quality service
• to privacy and confidentiality.
• to an advocate
• to make a complaint

Responsibilities

• treat staff and volunteers with respect and consideration
• provide sufficient information to enable staff to provide appropriate care and services
• respect the privacy of others attending the service
• participate in any decision making about your care
• observe safety procedures

EMPLOYEE

Rights

• to be listened to and treated with respect and dignity
• to work and be in a workplace which accepts and values people as individuals
• to a strong system of policies and procedures which are communicated and enforced
• to appeal decisions, and have complaints heard and acted upon
• to work in a place which is free from bullying, harassment and intimidation
• to receive education and training regarding diversity and cultureto attend to the requirements of cultural and religious practices

Responsibilities

• to follow and comply with legislation, policies, procedures and directions from managers or supervisors
• behave and interact in a way which is polite, respectful and appropriate
• learn about the cultural and linguistic needs of a client and their family
• follow lawful instructions provided by a manager or supervisor
• work with clients in a way that is fair, equitable and respectful

EMPLOYER

Rights

• to appoint and dismiss workers in accordance with proper industrial laws and to expect reasonable performance from their employees. ensure that bullying, harassment, and discrimination is avoided in the workplace.
• treat clients, workers, and stakeholders with respect.

Responsibilities

• develop and implement policies and procedures to ensure legal and ethical compliance of the service organisation.
• ensure that workers receive appropriate training and instruction, supervision, counselling, etc. as required by the industry.
• provide a safe workplace for all workers, clients, and stakeholders.
• ensure that the organisation caters to the cultural safety of workers and clients

Read

Take some time to read the following links that provide information about aged care rights and the rights of persons with disabilities.

Charter of Aged Care Rights

Convention of the Rights of Persons with Disabilities

Watch

For further information about the Charter of Aged Care Rights, watch the following video.

Your Role

Your role as a care or support worker will involve dealing with many aspects of client care. A job description will outline your duties and what activities you would be responsible for in a care support role. Some of these may include:

• assisting with personal hygiene
• assisting with eating and drinking and using feeding techniques
• assisting with oral hygiene and health care
• assisting with toileting and use of continence aids
• bed bathing
• dressing and grooming including assisting with pressure stockings
• shaving
• showering
• hydration and nutrition needs (including addressing dysphagia)
• maintenance of skin integrity and pressure area prevention
• mobility and transfer including in and out of vehicles and falls recovery techniques
• monitoring medication as appropriate to work role
• nail care
• pain management
• rest and sleep
• respiration

All people share basic common human needs that must be met if they are to survive and thrive, but individual people may require different levels and types of support to help them meet their needs.

Individualised support plans are designed to meet the specific needs of individual clients. In this chapter, you will look at why support plans are an important part of your work. You will see examples of support plans, and understand how they are developed.

Why do we Need to Plan?

In institutional-style care, people were seen mainly as having just physical and medical needs. This meant that the role of a disability or aged worker was focussed only on to helping the person to:

The problem with this medical approach to care was that these physical needs are only a small part of what we need as humans. Many other areas of the person’s life were often neglected.

Our needs can be categorised into many different areas:

Plans are not written just for the staff alone. They are there for the person you support to read, use and collaborate with you on. They must be written in a way that the person can understand. For some people, such as people with intellectual disabilities or dementia, this might include pictures or drawings. The people you support must be able to access their plan whenever they would like to. Use it as a roadmap that you both understand and negotiate before you begin.

Planning with a person should help them to:

• Maintain health, wellbeing and independence
• Maintain dignity
• Stay safe
• Utilise their strengths
• Reflect individual goals, values and preferences
• Promote enablement or re-enablement
• Enhance their quality of life

Individual support workers are required to deliver aspects of personal care to a diverse range of clients. Client usually has a personal care support plan or individualised plan, that identifies and outlines their support needs. This plan is usually developed in consultation with the client and their carers, doctor and other professionals.

It can cover all aspects of the client’s social, emotional, physical and cognitive care. Support workers may be responsible for working on a standalone personal care plan or the personal care aspects of the wider individualised care plan.

The purpose of the plan is to:

• provide clear direction for staff to support individuals
• identify support services required
• ensure the support services are meeting individual needs
• maximise participation and promote emotional wellbeing
• keep a record of individualised support and needs
• supports evaluation or review.

An individualised plan can address the requirements of a range of people in a range of settings such as:

• children
• older people
• people with disabilities
• young people
• infants
• The setting could be:
• an aged care facility
• a client’s home
• residential care
• community service settings.

In order to find out what a person’s needs are, a support person would need to spend time speaking with the person, their family and carers to find as much information as possible.

The individualised plan will also outline the care tasks to be performed and the level of client involvement in the task.

Individualised plans should be regularly reviewed with the client, and their primary carer if necessary, to ensure the needs of the client are still being met. This is especially important where the client's needs may have changed recently or there is confusion about the type of care being provided.

Case Study

Mary, a support worker, visits Luciano daily to help him get out of bed in the morning, shower, toilet, and dress. A portable hoist is available for the worker to use to transfer him. Mary also supervises Luciano’s morning medication and helps his wife to carry out his physiotherapy program to clear his lungs. The plan helps Mary to support Luciano in the way that he prefers. It helps Mary to understand what needs to be done, when it is done and how it is done. It also refers to ways to keep him safe. The plan gives Luciano some control, even though he has dementia, because he and his wife took part in developing the plan.

Individual Support Plan

Aged care and Disability services will have their own workplace documentation including Individual Support Planning templates to complete.

Generally, the information within an Individual Support Plan will include:

• Name of the client accessing the service
• Name of the service provider
• Start date of the plan
• End date
• Review date
• Client background
• Client aspirations and expectations
• Client goals
• actions to achieve their goals
• progress dates and accomplishments
• Client medical needs
• Aids, equipment and devices required by the client, e.g. walking aid
• Personal care including:
• teeth
• dressing
• showering/wash
• skin and nail care
• Eating and nutrition
• Social and emotional wellbeing
• Intellectual
• Values, beliefs and preferences

Read

KeepAble has developed a great resource to support staff and clients and have developed an eBook to assist with support planning.

The level of participation that a person wants to have with regard to meeting their personal support needs can range depending upon their own preference, ability, capability, needs and wishes of the family or carer.
Before these support needs are provided, it is important to find out exactly what their preferences are and confirm them from the very outset. Remember that these could also change over time so this may need to be re-evaluated at appropriate intervals.
It may be that you need to consult with your client at every interaction and discuss the task you are about to perform. Whilst this will have been discussed when developing the care plan, you may need to clarify with your client their level of participation for a new, or a variation of a procedure or activity. Furthermore, it may be the policy of your organisation that you confirm with the client the level of participation at every meeting. 

Note:

It is important to assist a person in maintaining their independence where their physical and mental capacity supports this by confirming with them that they can do. You can work with the client to support their efforts, rather than have them feel they are having things done to them that they could themselves.

Activity

Read the following links:

• Strategies for motivating, supporting and encouraging a client
• MyAged Care provides tips for healthy and active ageing

Write down 5 strategies that you plan to use to engage clients you are working with in the future. 

Watch

Watch the following video to learn further information about reablement.

It is essential to check a client's personal preferences before preparing equipment and the environment to deliver personal care and support. All individuals are the experts in their own lives and experiences, including their personal preferences, care, lifestyle and services, therefore their choices must always be respected.

The following information are essential factors to consider:

Note

Discussing and confirming a client's preferences should be conducted positively and communicated effectively. Meeting and talking with a person about their wishes first can ensure that the person is comfortable, feels safe and their personal needs are being met.

Tips for supporting a person with their preferences

• Consider the time of day best suited to talk with the person; sometimes may be better than others.
• Be prepared to have more than one discussion about their preferences; they may need repeated things or time to think about what they want.
• Ensure that during the discussion, you are prepared for any hearing or learning difficulties, using appropriate aids and support where necessary.
• When communicating, use positive body language, use simple language avoid jargon or complex terms and speak at an appropriate speed and volume.
• Use visual aids such as pictures and objects to communicate with the person.
• Only ask one question at a time and wait for a response before continuing.
• Ensure that you are aware of cultural and religious factors influencing the client’s thinking.

Importance of Confirming the Person’s Preferences

• Sometimes the person’s needs and preferences can change on a daily basis. Always confirm the details of the plan with the person before you begin, and let the person know what it involves. For example:
• The person might not want to undertake that task or activity today
• Something might be more important for that person on that day, such as a medical appointment
• The person might be feeling down or have different needs
• If you are unsure about something in the plan or have concerns, always check with the person first and then your supervisor if you need further clarification. Sometimes the support that is outlined in the plan might not be appropriate at that time. Consider the potential impact that personal support may have on the person and confirm concerns with your supervisor.

Note

Remember that in most cases, the client has the right to refuse care. When this happens, let your supervisor know, and then document the refusal in the client’s notes.Work with the person throughout the day to support the activities written in their plan where possible. For example, if the person has a disability and their plan outlines their interest in making new friends, help the person to find ways that they can do this. Promote independence and choice by providing or suggesting resources that can help the person to follow the plan more easily.

For example, if the plan outlines the person’s interest in reading, support them to find reading materials that meet their needs. These might include audiobooks, large print books or books in braille. You might suggest a visit to the library, help them to download software on an iPad or a new book onto their Kindle.

Case Study

Graeme is a double amputee living in an aged care facility. His plan gives instructions to help him to shower before breakfast, and most mornings, that is his preference. Today he has asked the support worker Fran to bring him his breakfast in bed. ‘You are so naughty!’ says Fran. ‘Come on; you know that you always have a shower first. And it’s written in your plan. Come on. Up you get. Graeme has been used to this response from support workers in the past. He has begun to understand that he does not have choices, and the only option is getting up for his shower. Sushma is a new worker who understands that this is not acceptable. Graeme has every right to change his day, no matter what the plan says. Sushma has been listening and gently interrupts. ‘You know, Fran, sometimes I really feel like having a shower later in the day, too. Graeme is allowed to make these choices for himself. It’s his day and his preference. We could easily bring you a tray in bed, Graeme, or you could sit in your chair and eat if you prefer. In this situation, Fran has taken away Graeme’s choices about his own body. She has used language that makes him feel like a child, making it difficult for him to speak up about his preferences. By giving Graeme information about his rights, and options to help him make a choice, Sushma has helped Graeme to make informed decisions.

Important

Work with the person throughout the day to support the activities written in their plan where possible. For example, if the person has a disability and their plan outlines their interest in making new friends, help the person to find ways that they can do this. Promote independence and choice by providing or suggesting resources that can help the person to follow the plan more easily.

In preparation to support activities with a client, you will use the plan and the person’s preferences as guidance. When you are to provide support with personal care, prepare everything that you will need before you begin. This might include preparing equipment, people or schedules. Here are some examples.

• Ask for extra help from other workers
• Prepare transferring equipment or mobility aids
• Gather new linen, clothing and the person’s toiletries
• Heat the bathroom in advance
• Order a taxi so that an out of home activity can be done on time
• Set up recreational activity
• Book a table at a café or restaurant or other service in the community
• Help the person understand how they can stay safe during the activity

Case Study

Maria’s plan outlines that she has two workers help her transfer from her bed to her chair to watch her favourite morning TV program. Today the support workers have been running a little bit late, and Maria has already begun watching her show in bed when they arrive to help. Rather than interrupt her show, the support workers complete other tasks first, and then help Maria to transfer to her chair after the show is finished.