Provide Support Services

Facilitation and collaboration with various people and support organisations is an essential element in the community health setting. You will be communicating with a range of different people in your role.

This may include communication between you and the:

• Client being supported
• Supervisor
• Care giver or family members
• Case managers
• Other support workers
• Other organisations
• Health professionals

The types of information being discussed can also vary and depend on the supports your client needs.

For example, you may need to speak to your supervisor to communicate an incident, or you may be required to reach out to an organisation to make a referral or an appointment on behalf of a client.

It is crucial that you always comply with your organisations policies and procedures before you reach out to any person ororganisation and ensure you always have the client’s consent before discussing any issues about the client.

Good, respectful communication can help the person to feel at ease. It provides the person with reassurance that you understand their needs and that they can trust you. Many support activities can be intrusive on the person’s privacy and dignity. When you dress or undress a person, or help them with personal care needs, the way that you communicate is important. You can help to promote trust, self-esteem and confidence in the way you support and communicate with the person. Let the person know what you are planning to do, and give them the opportunity to refuse. Talk to them during the activity. Give sincere praise when the person achieves something new, but do not be condescending in your praise. If there will be a change in the way or time that things are done, let the person know as far in advance as possible, and reassure them about what they can expect to have happen. This helps to instil trust and helps the person gain some control over the situation.

Important

Do not use baby talk or talk down to the person. Do not yell as if the person has a hearing problem, when they do not. This is insulting to many people with disabilities.

Providing Privacy

The right to privacy is a basic right. It is important to provide support that respects this right. Here are some examples.

Disclosure

There are some examples of information that you must pass on to others, even if the client has asked you not to. You must let your supervisor know if a client or other person tells you something that might put the client or others at risk.
You must breach the person’s confidentiality if you suspect or know that the client:

• Has been abused or have experienced signs that could be abuse or neglect
• Is at risk of harm, such as experiencing fall
• Is at risk of putting others at harm, such as driving a car when they are unsafe to drive or when they do not have a license.
• Is considering self-harm or has attempted self-harm

Providing support

There are important principles that must always be followed when you are providing supports to the person. Privacy, dignity, choice, independence, safety and good communication must underpin everything you do.
When communicating with clients to provide support services it is important to consider the rationale and processes of underpinning the way we deliver services to support planning and delivery and take the approach that every person is unique and their care and support should reflect this. Processes underpinning individualised support planning and delivery can include:

Assessment

This involves gathering information about the person's needs, preferences, goals, and strengths. This information can be obtained through interviews, observations, and assessments.

Planning

Based on the information gathered in the assessment, a personalized plan of care is developed. This plan should take into account the person's goals, preferences, and strengths, and should be regularly reviewed and updated as needed.

Implementation

The plan of care is then implemented, with the person's involvement and participation. This can include providing the person with the necessary information, skills, and support to achieve their goals.

Monitoring and evaluation

The plan of care is regularly monitored and evaluated to assess its effectiveness and to identify any areas that need to be adjusted. The person's input and feedback is important in this process.

Individualised support planning and delivery aims to empower individuals, respect their autonomy and choice, and provide them with the necessary support to live a fulfilling life. It also allows for flexibility and adaptability, which is important in meeting the ever-changing needs of older adults.

Involving the client in their care, so that you can identify whether your service is meeting their needs or not, is important. It will allow the client to discuss their reasons for needing a change in their plan.

Principles of Care

Basic principles of person-centred practice, strengths-based practice and active support can include:

• Person-centered practice, strengths-based practice, and active support are all approaches that focus on empowering individuals and promoting their autonomy, choice, and well-being.
• Person-centered practice is an approach that puts the individual first and at the centre of everything the service does. It involves listening to and respecting the person's needs, preferences, and goals, and working with them to create a personalized plan of care. Person-centered practice also values the person's autonomy, self-determination and choice, and encourages them to be active participants in their own care and helps to improve their experiences and outcomes.
• Strengths-based practice is an approach that focuses on identifying and building on a person's strengths, abilities, and resources, rather than focusing on their deficits or problems. It involves working with the person to identify their strengths and capabilities and building on them to achieve their goals. It also empowers the person to take an active role in their care and support.
• Active support is a person-centered approach that focuses on promoting the person's autonomy, choice, and well-being. It involves providing the person with the information, skills, and support they need to be active and engaged in their daily life, and to make informed decisions about their care and support. Active support also emphasizes the importance of involving the person in the planning and implementation of their care and support, and encourages the person to be active participants in their own care.

Principles of respectful behaviour

The principles of respectful behaviour involve treating others with dignity, kindness, and compassion, and recognising and valuing their unique needs, preferences, and perspectives. Respectful behaviour is not only important in aged care but also in any setting where people interact and communicate with one another.

Some specific principles of respectful behaviour include:

Factors that affect people requiring support

As a support worker you will need to be aware of stressors that may impact an older person or person with disability.
These can include:

• social isolation
• lack of access to treatment
• financial stress
• change of living arrangements
• grief
• a loss of their independence or mobility
• a shift in relationships
• level of education
• culture
• age
• gender
• their first language spoken
• socio-economic status.

There are many diverse stressors that can be experienced.

Aged Care Service delivery models

There are different types of aged care service delivery models and it’s important to consider the specific needs and unique circumstances of the individual when selecting the best one. Often the organisation you will be employed with will already have a service delivery model that they use. Keep in mind that the Australian Government subsidises aged care in Australia and all aged care providers have a responsibility to provide quality aged care services.

The follow provides examples and descriptions of service delivery models that are used:

Aged Care Home/Residential Care

Residential Aged Care Delivery Models will highlight strategies for developing effective residential aged care delivery models. Presentations and case studies will explore changing and future models of care, resource requirements for complex, CALD consumers and supportive models for diverse needs groups. It will highlight the need to be flexible and responsive in care delivery, increase relationships and continuity of care.

Help at home services

Help at home assists older Australians who are able to keep living in their own home, but need some help.

There are different types of flexible care, depending on the person’s needs. They all help with day-to-day tasks, and to restore or maintain independence.

Flexible care services

Flexible care is for care recipients who need a different approach than what residential and home care can offer.

Continuity of support services

This model provides continuity of support to older people with disability who are currently receiving state-managed specialist disability services, but who are not eligible for the NDIS.

Other models include:

• Disability Services Models
• National Disability Insurance Scheme (NDIS)
• Social Model of Disability
• Social Care Model for Indigenous People

Read

National Standards for Disability Services

Daily Living Activities

Daily living activities, also known as activities of daily living (ADLs), are the basic tasks and responsibilities that individuals need to perform to maintain their personal care and well-being. ADLs include:

• Bathing: washing oneself, including hair and skin.
• Dressing: putting on and taking off clothes, including fastening buttons, snaps, or zippers.
• Toileting: using the bathroom, including bowel and bladder care.
• Transferring: moving from one place to another, such as getting in and out of bed, a chair, or a wheelchair.
• Ambulating: walking, using a cane, walker, or wheelchair.
• Feeding: preparing and eating food.

In addition to ADLs, Instrumental activities of daily living (IADLs) are also important for older adults, these include:

• Medication management: taking medication as prescribed.
• Meal preparation: planning and cooking meals.
• Housekeeping such as cleaning, laundry, and other household tasks.
• Buying groceries, clothing, and other necessities.
• Handling finances, paying bills, and managing bank accounts.
• Answering and making phone calls.
• Driving or using public transportation
• Attending social or recreational activities
• Carer support

In 2015, approximately 856,100 people were identified as primary carers and almost 2.7 million Australians were identified as carers (Carers 2015, ABS). Carers provide unpaid care and support to their family or friends with disability, long-term health issues or who are frail or aged. They can help with daily activities such as preparing meals, bathing, dressing, going to the toilet, moving around and taking medicine. Every carer has a unique situation and maybe taking care of someone living with disability, dementia or mental illness.

The following table provides links to state government support for carers.

Promoting and maintaining independence

It's important to remember that every individual's needs and abilities are unique, so a personalised approach should be taken.
Promoting and maintaining independence in aged care can be achieved through various approaches such as:
Encouraging and assisting with activities of daily living (ADLs) such as dressing, grooming, and eating.
Offering physical and occupational therapy to improve mobility and strength.
Providing opportunities for socialization and engagement in activities that interest the individual.
Allowing for autonomy and choice in decision-making and daily routines.
Providing assistive technology and adaptive equipment to support independence.
Encouraging family involvement and communication to provide additional support and understanding.

Enabling inclusion and participation

Inclusion and participation refer to the idea that all individuals, regardless of their abilities, background, or circumstances, should have equal opportunities to be included and actively participate in their communities.

Suggestions when working with people in aged care or disability can include:

• Fostering a sense of community and belonging among residents, staff, and family members.
• Creating opportunities for socialization and engagement in activities that interest the individual.
• Encouraging and facilitating communication and collaboration among residents and staff.
• Providing information, education, and training to residents and staff on topics such as disability, aging, and cultural diversity.
• Involving residents and their families in care planning and decision-making.
• Making facilities and services accessible and inclusive for people with disabilities and different cultural backgrounds.
• Offering language and translation services to support communication and understanding.
• Encouraging community engagement and integration for those who are able.

Together, inclusion and participation work towards creating a society where everyone can fully participate and thrive regardless of their abilities or background. In aged care, it means that older adults are given the opportunity and support to be active members of their communities and to live full and meaningful life.

For many clients there will be a range of equipment and aids that have been identified to help with support. An occupational therapist or physiotherapist will have to assess the client before the care plan is initiated. These aids and equipment are designed to make procedures safer for the client and worker and to promote the independence and dignity of the client.
When determining a person’s support requirements, you will also need to confirm the required equipment, any aids or devices and processes needed. These may include:
wheelchairs and other transport devices

• mobility aids including:
• walking sticks
• tripod or quad sticks
• walking frame
• elbow frame
• elbow crutch
• pair of crutches
• lifting and transferring aids used by a worker
• modifications of beds
• breathing devices
• scales
• continence aids
• personal audio-visual aids
• modified eating and drinking aids

Read

Read more to see the various products available on the market for meeting personal support needs.

If there are any identified risks whilst providing support, then these must also be considered to ensure that the support given is undertaken safely. This information would be according to the individualised plan, for example, an identified risk may be that the client’s skin can tear easily so taking measures to avoid this risk. Another risk may be dealing with a client’s aggressive behaviour or the way in which you undertake your work activities such as moving and handling equipment.
Organisation policies, protocols and procedures will also provide guidelines and standards you will need to follow which may relate to specific technical support activities such as how to safely adjust equipment to ensure the client is not at harm.

What is assistive technology?

Assistive technology is any type of item such as a piece of equipment, system or software program that can be used to maintain, increase or improve functional activities in a person’s life.

Assistive technology can benefit a wide range of people, including those with:

• Disabilities
• age-related frailties
• noncommunicable diseases; and
• rehabilitation.
• Assistive technology in aged care and disability can support people with their daily living activities such as:
• self-care
• continence and hygiene
• communication
• mobility and transferring
• cognition and memory loss
• vision and hearing

The scope and breadth of assistive technologies in aged care is quite wide and can include various types of devices and equipment to help older adults maintain their independence and improve their quality of life. Some examples of assistive technologies in aged care include:

• Adaptive equipment for daily living such as reachers, grabbers, and dressing aids
• Medication management systems to help with pill reminders and dosage tracking
• Telehealth and remote monitoring systems to allow for virtual consultations and monitoring of vital signs
• Smart home technologies such as motorised blinds to control light in the home, motorised windows to open and close them and remote control fans or air conditioning.

Much assistive technology is aimed at supporting people with dementia and their carers at home. Major benefits can be gained from introducing technology into residential facilities. People with dementia and staff benefit as jobs are made safer, easier and more supportive of person-centred care. It can range from simple things like walking sticks to sophisticated equipment like satellite-based navigation systems to find people who have walked away from facilities. It includes kitchen technologies designed for residential care, nursing aids and new administrative software.

It is worth nothing that assistive technologies are continuously evolving, so new solutions and devices are constantly being developed and introduced to the market.

Example

Motion sensors can be placed in bedrooms and other room that are used by people who may be prone to falls.
Other assistive technology that can be used include:

Read

Read the information from the Australian Disability Clearinghouse on Education and Training (ADCET) for further information about how assistive technology can make things possible!

Watch

For further information about Assistive Technology, watch the following 2 videos from the NDIS.

What gaps are there in assistive technology?

Depending on the type of assistive technology there can a variety of gaps. In a report conducted by the Australian Healthcare Associates, among other things, found that consumers:

• were not aware of the range of assistive technology that can help them, even though it found that consumers needed to know but did not have access to information.
• would benefit from receiving information and advice about purchasing assistive technology to be able to select products that suit their needs
• frequently think that assistive technology is for people with disabilities which can deter them from seeking any further advice or information.
• health professionals also have knowledge gaps relating to assistive technology, their products, services and programs to share information with clients or how to access them.

Although there are over 65 different national, state and territory programs that provide assistive technology to older Australians, the report found that access is inequitable and the programs aren’t designed to respond to changing needs of people with disabilities and older Australians.

Increasing awareness about Assistive Technology, integrating it into the health system at all levels and setting up education and training for service providers who deliver assistive technologies can help to promote access to assistive technology for all people who need it.

Support workers work in partnership with other health professionals in all aspects of their role. Primarily your organisation will have specific guidelines, policies and procedures relating to the roles and responsibilities of administering medication.
‘All regulated healthcare professionals (including pharmacists, medical practitioners, nurse practitioners, registered and enrolled nurses) are subject to national, state and territory legislation and regulation governing their professions, including their roles in medication management. Healthcare professionals who are authorised by legislation to issue a prescription for the supply of medicines are referred to as prescribers, and include doctors, dentists, optometrists, midwives and nurse practitioners.
Registered nurses are qualified and legally authorised to administer medicines under the Health Practitioner Regulation National Law Act 2009 and relevant state or territory legislation and regulation. Enrolled nurses work under the direction and supervision of registered nurses. Under the Health Practitioner Regulation National Law Act 2009, all enrolled nurses may administer medicines, except for those who have a notation on the register against their name that reads, ‘Does not hold Board-approved qualification in administration of medicines.’ (National quality use of medicines Medication management in residential aged care facilities Guiding Principles n.d.)

Read

For further information about the Guiding Principles for Medication Management in the Community (2022), that promote the safe, quality use of medicines and medication management.

In addition, also read the Disability Services Medication Framework for Individuals and Disability Service Providers (2016)

There are several guidelines to consider when administering medication. These are generally knowns as the Rights of safe medication management to ensure you have the:

The following information describes the "Rights" of administering medication. Keep in mind that each organisation will have their own procedures and processes when it comes to administering medication.

General procedures to consider if a client refuses to take their medication are outlined below:

• Ask the client why they do not wish to take their medication.
• Explain to the client the reason for taking the medication and the possible effects on their health if medication is not taken.
• Wait 15 minutes and ask the client to take the medication again.
• If the client still refuses then the prescribing Doctor must be contacted for instructions. If the Doctor is unavailable, call the after hours Doctor, Pharmacist or Poison’s Information Centre.
• Observe the client for changes in behaviour or well being as a result of the medication mistake and report these to the Supervisor or Doctor.

• Report and record the incident using your organisations reporting documentation processes.

Right to refuse

Informed consent is given voluntarily to agree to health care treatment and is a person’s decision. If the person refuses treatment including medication, even if a substitute decision maker (SDM) has given consent, then the treatment cannot be given under normal circumstances. (ACQSC, Informed consent n.d)

Remember

It is important to comply with your organisations policies and procedures about administering medication. You must not administer medication if you do not have the explicit and accredited training.

Think

If a Client refuses to take their medication, comply with your organisations policies and procedures and seek guidance from your supervisor if you are in doubt.

Read

Look at the following link from the North West Support Services Inc. that provides further guidance and procedures for administering medication.

It is important to ensure carers and family members are consulted with in the care of the person you are supporting to ensure they are included in all steps of the process. This will also help you to determine any specific physical, cultural or sensory needs or preferences of their loved one.

Respecting Family Carers

If the person lives in their home with a family carer, the carer may wish or expect to be included in support activities. It is important to help the carer to continue this role, and to actively help the person to make choices and provide support. Be guided by the client and their family supports, and consider yourself as another pair of hands to help with physical needs. The client’s relationship with a family member is different than a client-support worker relationship. If the client lets their family member make choices for them, this is the client’s choice to allow this.

While providing care services to the client, it is vital to include the family and carer in the services delivery program to promote the health and enhance the recovery of the client. The carer and family members have a better understanding of the client's health status and the problems they face when they are involved. Involvement of family members helps to design the program based on the client's needs. The carer’s participation in the planning and designing of the service delivery program helps to implement the plan to cater to the needs of the client.

Care provided by family members and friends promotes the community care system as it encourages the person who requires care to stay in their home. The Commonwealth Government assists in the provision of informal care to the people through the carer’s allowance and payment. The carer is eligible for the carer support program, HACC (Home and Community Care) services, Respite care and dementia education and support. It is important to recognise that the families and friends provide that majority of support and assistance for older Australians. It is recognised that supporting family carers is central to delivering a more person-centred approach to meet your obligations and responsibilities. It is imperative to understand the role and importance of carers and family members for a person with care needs.

Legal framework means a broad system of rules that governs and regulates decision-making, agreements, laws, etc. Service providers, as set by industry standards, have legal and ethical responsibilities towards their clients. This is to ensure that clients consistently receive high quality and safe support services. This means that both employers and individual support workers must fulfil legal and ethical responsibilities by following safe work practices and as guided by the legislations.

Legislation, roles and responsibilities

There are a number of laws and regulations that relate to providing personal support in a care environment.

Among these are workplace health and safety, privacy, the protection of children, discrimination and equal opportunity. Some legislation includes:

• Disability Discrimination Act 1992.
• The National Disability Insurance Scheme Act 2013
• Privacy Act 1988
• Workplace Health and Safety Act 2011
• Children and Young People Act 2008.
• Aged Care Guidelines
• Aged Care Diversity Frameworks
• The Aged Care Quality Standards
• The Charter of Aged Care Rights
• User Rights Principles
• Disability Discrimination Act (1992)
• Convention on the Rights of Persons with Disabilities
• Racial Discrimination Act 1975
• Sexual Discrimination Act 1984
• National Disability Insurance Scheme Act (2013)

It is important to also consider the legal and ethical requirements that impact a community health service setting and the impacts they have on different roles, particularly when a client is at the centre of care.

The following table outlines how roles and responsibilities are applied in an organisational context and through individual practice:

Human rights

Human rights are fundamental to the way we interact with other people and the value we see in their ability to survive and thrive in our society. The Universal Declaration of Human Rights is an important document which recognises the inherent human rights of all people, regardless of who they are or where they live. The declaration covers the right to free speech, the right to education, health, life, social and economic security, and human dignity.

Discrimination

Discrimination means making an unfair decision made based on a characteristic of a person, such as having a disability or being from a particular race or gender. In Australia, discrimination is against the law.. In a workplace, it is important that everyone understands discrimination laws and how they protect people from discrimination.

Dignity of risk

Many human activities include a degree of inherent risk. Risk can be physical as well as social and emotional. Activities, particularly those which involve some manual or physical tasks, can be associated with physical risk. These risks need to be managed and controlled through an appropriate system of workplace controls including a risk management assessment and implementation of a hierarchy of controls to remove or reduce the risk. Dignity of risk does not mean that a person should ever be placed in a situation where they may be injured or put at risk of harm. The dignity of risk is having the freedom to make decisions and choices that may expose an individual to a level of risk. As a worker you may need to promote the independence and dignity of the client, however, they still have a duty of care to ensure their health, safety and well-being whilst doing so. Always remember to report any potential or actual risks, hazards or any changes of a person’s health status to the supervisor.

Work role boundaries, responsibilities and limitations

When you are working with a person and helping them with their support needs, it can be tempting to do everything the person asks you to do. It is important to maintain your professional boundaries and follow your service’s policies and procedures, even if the client asks you to do something differently. You can refuse to do a task that breaches policy by being polite but firm. Explain to the client that you are not allowed to perform that task. Let them know that you could get in trouble for breaking policy if you do.

Clients might have requests that can breach policy, such as asking you to:

• Move heavy items of furniture or climb a ladder to clean something
• Allow them to smoke inside while you are working
• Transfer them without their mobility equipment or transfer machine
• Use a banned chemical like bleach to clean their bathroom.

It is important to follow policy, and the client has the responsibility to follow the rules of your service as well. By breaching these rules, you encourage the client to insist that other workers do the same, put yourself and the client at risk, and leave yourself open to disciplinary proceedings for breaching rules. When you agree to break rules that are outlined in policies and procedures, you also make it more difficult for other workers to encourage the person to follow procedures. You can refuse to do a task that breaches policy by being polite but firm. Explain to the client that you are not allowed to perform that task. Let them know that you could get in trouble for breaking policy if you do. If you are in doubt, always seek guidance from your Supervisor.

Mandatory Reporting

Mandatory reporting may be required by law or a requirement that the organisation has mandated.
These provide clear processes for employees to follow in the event of incidences occurring in the workplace. It can also provide frameworks for reporting such as alleged or suspected situations of abuse or critical incidents.

Different organisations will have compulsory reporting, for example:

• a reportable assault
• unlawful sexual contact
• unexplained absences (i.e., missing person)
• reporting a notifiable incident
• Workplace Health and Safety mandatory reporting
• financial reporting
• substance abuse
• physical injury.

Restrictive Practices

A restrictive practice is any practice or intervention that has the effect of restricting the rights or freedom of movement of an aged care consumer. Under the legislation, there are five (5) types of restrictive practices:

• Chemical restraint
• Environmental restraint
• Mechanical restraint
• Physical restraint
• Seclusion.

The definitions of restrictive practice and the five types of restrictive practices were implemented to provide clarity to providers on what constitutes a restrictive practice and the circumstances for the use of a restrictive practice. These definitions are aligned with those applied under the National Disability Insurance Scheme.

Aged Care

The Aged Care Act 1997 and the Quality of Care Principles 2014 have been updated to clarify and strengthen approved provider requirements in relation to the use of restrictive practices in aged care. These changes protect senior Australians receiving aged care and services and ensure that providers understand and meet their obligations in this regard.
Source: Aged Care Quality and Safety Commission

Disability

The Disability Act 2006 protects the rights of people with disability who submit to the use of restrictive practices or compulsory treatment. A small number of people with a disability are subject to restrictive practices or compulsory treatment, which are used to protect the person from causing harm to themselves or others.

The use of regulated restrictive practices by disability service providers must be included in a behaviour support plan and reported to the Victorian Senior Practitioner.

The use of regulated restrictive practices by registered NDIS providers must be included in an NDIS behaviour support plan prepared by an NDIS behaviour support practitioner and reported to the NDIS Quality and Safeguards Commission.

When can restrictive practices be used?

Everybody has a right to move freely, but sometimes people might hurt themselves or hurt other people. Providers can use restrictive practices to stop harm to self or to others.

Physical restrictive practices

Some common restrictive practices in residential aged care that are physical can include:

• clasping a person's hands or feet to stop them from moving
• applying restraints such as leg, wrist, ankle or vest restraints
• seating residents in chairs with deeper seats, recliners or rockers where they are unable to stand up from, or moving their mobility aids
• It may also include confiding a person in a residential facility or specialised unit

Pharmacological restrictive practices

Some medications prescribed for residents in residential aged care can have the effect of restricting a person's movements or their ability to make decisions. Some medications may cause sedation and can be prescribed for pain relief, whilst others such as psychotropic medication can include stimulants, antidepressants, anti-psychotics, mood stabilizers and anti-anxiety agents.

Physical restraint effects

The use of restrictive practice can present with serious human rights breaches therefore it is crucial that ethical consideration is taken into account. While in certain circumstances, physical restraint may be necessary to mitigate risks to a resident or others in an emergency, the impacts on a person receiving physical restraint can include:

• shame
• fear
• anxiety
• loss of dignity
• agitation
• lower cognitive performance; and
• depression

Documentation Requirements

Under the NDIS Rules 2018, all regulated restrictive practices must be thoroughly detailed in a Behaviour Support Plan. This document includes information about triggering behaviours and what causes them and how to reduce or stop the behaviours from happening.

The following points are helpful to consider in a behaviour support plan:

• What is the description of the restrictive practice to be considered
• Why is it being used? What strategies were tried before restrictive practice was considered?
• Process - What detailed instructions about how, where, when the restrictive practice will be used and for how long?
• Recording - How will you make sure that all incidents are recorded or reviewed? How will you monitor the effectiveness of the restrictive practice and how will you monitor any side effects?
• What strategies do you have in place to reduce or eliminate the restrictive practice?
• Training - How will training occur with key staff about restrictive practices?

When a Behaviour Support Plan is being written, consider the following suggestions:

• Keep it simple
• Use simple language.
• Simplify your font, layout and design
• Keep to short sentences
• Use visual images if required
• Highlight what is important
• Read and review - Check your work. Does it make sense? Is it easy to read? Have you captured all relevant information?
• Get it checked! - Have your work colleagues, supervisor or carer review the information. Is it clear? Does anything need amending?

Positive Behaviour Support

Positive behaviour support is about creating individualised strategies for people with disability that are responsive to the person's needs that reduces and eliminates the need for the use of regulated restrictive practices. It focuses on evidence based strategies and person centred supports that address the needs of the person and underlying causes of behaviours or concerns, whilst protecting their quality of life and dignity. It helps people live better lives, with less behaviours of concern through changing things that help a person feel better.

Positive Behaviour Strategies

Strategies that reflect positive behaviour support include:

• Respecting a person
• Upholding a person's human rights
• Complying with legislative requirements
• Supporting a person by doing tasks and activities they like
• Going to places that a person likes
• Stopping things that a person does not like
• Policies and Procedures

Policies and procedures must be implemented in your workplace if using regulated restrictive practices, which may include processes and policies relating to:

• Behaviour Support Plans and Implementation
• Informed Consent
• Privacy and Confidentiality
• Client Rights and Responsibilities
• Authorisation of Regulated Restrictive Practices
• Record Keeping and Reporting
• Professional Development
• Reportable Incidences

Read

Click on the Fact Sheet link to access information about Behaviour support plans from the Aged Care Quality and Safety Commission.

Legislation and Frameworks

The following information provides various legislative frameworks and Standards that relate to restrictive practices in Aged Care and Disability:

• NDIS Practice Standards
• NDIS Act 2013 (Section 9)
• Aged Care Quality Standards
• Quality of Care Principles 2014
• Aged Care Act 1997
• Convention of the Right of People with Disabilities
• NDIS Restrictive Practices and Behaviour Rules 2018
• NDIS Provider Registration and Practice Standards Rules 2018
• NDIS Incident Management and Reportable Incident Rules 2018
• Framework for reducing restrictive interventions - VIC
• Regulated Restrictive Practice Guide
• The Positive Behaviour Support Capability Framework

Ethical considerations

When we think about ethical considerations, the fundamental human rights of a person must be assured according to relevant legislation. Before any assessment is carried out, the rights of a person exhibiting challenging behaviours are being met. This may include making sure that the person has:

• a safe environment to live in
• access to social and community support and regular activities
• the respect of staff and service providers
• The United Nations Convention on the Rights of People with Disabilities (2006) states that a person should be "guaranteed freeform from torture and from cruel, inhumane or degrading treatment or punishment" (Article 15). Further, it states that states should "protect the physical and mental integrity of person's with disabilities, just as for everyone else" (Article 17).
• Professional, ethical guidelines must be complied with by all practitioners. Practices that are condoned include:
• degrading or demeaning a person
• involve intimidation or aversive outcomes
• involve denial or access to basic supports or prevent people from fulfilling their basic needs
• involve wrongful imprisonment
• give rise to assault or abuse or act in any way that causes physical pain or serious psychological distress; or
• involve the unauthorised use of medication

Read

For further information regarding Codes of Ethics, you can access the following documents:
Australian Psychological Society (APS) Code of Ethics
Australian Community Workers Association Ethics and Standards
The Department of Health and Human Services Code of Conduct for Disability Workers

Example

Some clients can be insistent and may even try to manipulate you to encourage you to break the rules. They might say things like ‘All the other workers do it, why can’t you?’ or ‘Life is so hard for me already, I’m only asking you a small favour’. Remember that your own safety is a very high priority, and that you have the legal responsibility to look after yourself and others in the workplace.

A safe workplace is everyone’s right. Workers and employers alike have a role to play ensuring a workplace is safe. However, employers and workers have quite different responsibilities under the law when it comes to safety.
The responsibilities of employers include:

• Providing safety equipment (such as PPE) and instruction in its use
• Making sure that the workplace is safe
• Providing training in manual handling and other safety issues
• Acting on incident reports or near-misses.

Responsibilities of workers include following all reasonable instructions, reporting unsafe situations or practices, and taking reasonable care not to do anything which could put others at risk of harm. For example: It is highly unethical to abuse and neglect people, and there are laws created against this( e.g. mandatory reporting for suspected cases of abuse and negligence).

Workplace Health and Safety Laws and Regulations

Health and safety are the concerns of every person who enters a workplace. Legislation outlines the roles and responsibilities of every Australian employer and worker to protect yourself and others from harm. In the community services workplace, this includes the safety of clients or residents, family members, visitors and volunteers. These laws are made and enforced by different levels of government.

Here are some examples:

• The Commonwealth (Australian Government) National work health and safety laws, such as the Workplace Health and Safety Act 2011 (Cwth)
• State and territory governments, State and territory legislation and regulations regarding workplace safety, such as codes of practice
• Local councils and shires Local council bylaws, such as building codes and food safety

Legal Frameworks for Health and Safety Work Health and Safety Legislation
Until 2012, each Australian state and territory had its own act of legislation relating to work health and safety, which could lead to confusion. The national Workplace Health and Safety Act 2011 (Cwth) (the WHS Act), along with WHS regulations and codes of practice, is referred to as the Model WHS laws. The WHS Act is in place in all states and territories except Victoria and Western Australia. In Victoria, the legislation is called the Occupational Health and Safety Act 2001.

In Western Australia, the Occupational Safety and Health Act 1984 provides health and safety legislation. This is likely to change in the future, with WA closer to adopting the Model WHS laws than Victoria.

To help you identify the current WHS legislation covering your project, the table below lists the WHS Act and WHS Regulation of the states and territories of Australia as well as their respective regulatory body for work health and safety. 

Manual handling procedures

The most common cause of injury or illness was 'Lifting, pushing, pulling or bending' (24.2%) as recorded in July 2017 – June 2018 by the Australian Bureau of Statistics, therefore, as a care support worker, it is crucial to be mindful of manual handling processes. Manual handling procedures provide guidance for all staff in manual handling to ensure that risk management strategies are in place to maintain a safe working environment. Working in aged care or disability presents a variety of potential hazards and injuries as you will be required to perform a range of physical tasks, known as manual handling. It is very important for you to know how to perform these tasks safely to avoid injury.

Manual handling tasks require you to:

Nearly every task you perform in an aged care or disability setting will include some form of manual handling where you might be required to:

• Help a person to walk
• Use a computer
• Take part in an activity session such as yoga or dancing
• Help a person to shower
• Transfer a person using a hoist
• Clean a bathroom and toilet.

Any type of activity that involves movement puts you at risk of injury from falls, sprains, damage to your spine or muscles, stiffness and pain. Manual handling injuries cause significant risks to workers in your sector.

Your workplace must provide you with training in manual handling postures and techniques. During this training, you will learn certain universal rules that apply when transferring any load. When working in the healthcare industry, employers often require proof of manual handling training. Manual handling is the use of force exerted by a person to lift, move, push, pull, or carry people and equipment. Due to the regular handling of patients, manual handling in healthcare is a common workplace injury.

Risk management is when your organisation has processes in place to identify, assess and control risks and potential hazards in line with the hierarchy of control.

A risk assessment is a formal process which involves using documents such as a risk assessment document. This helps staff to:

• Decide whether the risk is high enough to take action
• Consider how urgent the risk is
• Determine how the risk should be managed.
• A risk assessment should be tailored to the workplace and to the type of activity being undertaken.

For example, manual handling risks can be assessed using a manual handling risk assessment. Examples and templates for this type of risk can be found on health and safety websites such as Safe Work Australia or the website of your state or territory authority.

The hierarchy of controls

The hierarchy of control is a tool used to help you to work through safety problems and reduce the risk.
Here are each of the levels of the hierarchy of control.

Eliminating the Risk (Level One)

Eliminating the risk is the highest level of protection and is the most effective control. Eliminating the hazard altogether creates the most effective control.

Substituting (reduce) the Risk (Level Tw0)

The hazard is replaced with a safer alternative.

Isolate the Risk (Level Three)

A hazard is restricted or confined. Think about how an x-ray is done in a room and the radiographer goes into a separate room.

Engineering Controls (Level Four)

Engineering risk control is the process of designing and installing additional safety features to workplace equipment. For example, placing a safety guard on a machine.

Administrative Controls (Level Five)

Level five of the hierarchy is administrative controls. These are measures the management and chain-of-command can implement to reduce the likelihood of a risk occurring. For example, placing a hazard/warning sign in a hazardous area, e.g. when a floor is wet.

Personal Protective Equipment (Level Six)

The final level in the hierarchy of risk control is the use of personal protective equipment (PPE) which sits at the lowest level as it is the least effective. The most common examples are wearing high visibility clothing, safety shoes, gloves, masks, aprons.

If there are any identified risks whilst providing support, then these must also be considered to ensure that the support given is undertaken safely. This information would be according to the individualised plan, for example, an identified risk may be that the client’s skin can tear easily so taking measures to avoid this risk. Another risk may be dealing with a client’s aggressive behaviour or the way in which you undertake your work activities such as moving and handling equipment.

What are risks?

Risk refers to the chance or likelihood that a person could be hurt or harmed. Harm can take many forms including:

• The result of physical risks, such as an uneven or slippery floor
• Due to errors such as mediation given incorrectly
• Related to the person’s health
• The result of abuse
• Cause by actions and behaviours of others

If harm is suspected and you feel a person may be at risk of physical or emotional harm, you must report your concerns as soon as you can in person to your supervisor. This must be followed up with a report that meets your organisations reporting requirements, e.g. an Incident Report. The incident must be documented in the person’s file notes.

Risk of Abuse

• You must report anything that you see or hear that makes you concerned that a client or resident might be being abused. You might become suspicious that a person or child is being or has been abused if you see or hear any of the following:
• Unexplained injuries
• Bruises, burns or other injuries
• Injuries, redness or bleeding in the genitals

Emotional changes

• The client is frightened of a particular worker or other person
• Signs of depression or withdrawal

Disclosure

• The person or another person might tell you or imply that they are being abused

Observation

• You witness another person doing harm

Organisation policies, protocols and procedures will also provide guidelines and standards to follow which may relate to specific technical support activities such as how to safely adjust equipment to ensure the client is not at harm.

You may be required to assist with a range of tasks that have inherent risks for a client such as:

• Application of prostheses – a prosthesis is an artificial device that replaces a missing or malfunctioning body part, which may be lost through trauma, disease, or congenital conditions. These devices can include the obvious artificial legs and arms but also include hearing aids, false teeth, glass eyes and spectacles.
• The risks may include infection due to the integrity of the skin on the stump, which may be bruised or have chafing. The area may need to be cleaned first or the device checked for any issues or modifications required.
• Application of anti-thrombotic stockings – these are used to reduce the risk of blood clots in the legs, and oedema and to improve circulation, anti-thrombotic stockings can be difficult to apply.
• To reduce the risk of tearing the client’s skin you may need to use an assistive device to support the application.
• Simple eye care – eye wash or saline solution may be used to bathe a client's eyes after surgery or before eye drops or cream is applied.
• Risks to the client may be infection control so you may need to wear gloves, and fresh cotton pads, follow a specific procedure for cleaning and only wipe once, in one direction.
• Personal safety and security risks associated with looking after a person that you are providing support could also include:
• Muscular strain from lifting a person onto a bed.

The strategies to minimise or eliminate the risk could include:

• ensuring that you are trained in how to lift people safely
• using equipment or devices as required
• applying bed or chair mechanics to aid a person’s transfer
• using appropriate techniques such as bending with the knees and not with the hips, or core body strength and correct positioning of feet.

Physical or psychological harm caused by the aggressive behaviour of a client.
The strategies to minimise or eliminate the risk could include:

• training in dealing with aggressive clients
• identifying and understanding the behaviours and triggers of the client.
• elimination of anything, or anyone, that could possibly trigger the behaviour
• if a known trait, then try to avoid being alone with the person if possible
• using devices to support emergencies such as alarms or emergency call buttons

There are other identified risks that may be general to the environment or specific to the activity that you are undertaking such as infection control. This may include:

• food preparation
• handling contaminated objects
• disposing of infectious waste
• personal hygiene practices
• transmission of biological infections
• handling contaminated sharps
• occupational exposure to body fluids.

As discussed, there are many potential risks or actuals risks that can occur with a client. The following provides information on how to respond to some of these:

Moving a fallen client in a restricted space using slidesheets

If a client has fallen in an area where a hoist cannot be used (for example, between a toilet and a wall), the preferred option is to slide them to an area where you can use a hoist. For this technique, you need at least two carers and two slide sheets. Sole carers working in the community may need to call an ambulance.

1. Assess the environment and safety for you, then the client
2. If the client cannot get up, use two slide sheets, positioned under knees or in small of back depending on how they have fallen. Or you can roll them in the usual way – ensure the slide sheets are under the hips, but do not worry if you cannot get under their shoulders as well
3. With two carers on their hands and knees, or with one knee up, move the client onto the top sheet by sitting back onto your heels. Keep your arms straight and use the momentum of sitting back onto your heels to move the client – it usually takes a few small manoeuvres to straighten the client if they need to come through a doorway
4. Move the client far enough out so they are in a space large enough to be hoisted
5. Where possible, a third person should look after the client’s head – the two carers moving the client must work at the speed with which this third carer can safely move
6. Be aware that the client’s elbows and feet are at risk of being knocked during this procedure
7. When the client is stable, hoist them to a bed or trolley.

Using Slings

There should be a risk assessment prior to moving and handling that includes the client’s current mobility and any other factors that affect the safety of the planned movement of the client. The risk assessment must also take into account how many carers are required to complete the task. This is particularly important in the community, where carers may be working in isolation.If the risk assessment or client profile indicates that more than one person is required to hoist, that is what must happen. A robust risk assessment is essential and carers must use moving and handling techniques consistent with the risk assessment.

Considerations that should be made when using slings:

• All slings must be checked prior to each use for rips or tears
• Check the safe working load, usually displayed as SWL, which must be written on the sling (SWL indicates the load to which the hoist will work)
• Check due date displayed for next maintenance check. Do not use if out of date
• Size – measure the length and width or girth of client. For length, move from the base of the spine upwards to check that the sling is long enough. For width/girth, check that the sling will reach past the client’s arms to enclose them safely
• Once the sling size is known, write this in the relevant client notes and care plan
• For most sling types, the lower sling loops should be positioned so they cross over between the client’s legs, which also helps to maintain the client’s dignity
• Get the client to put their hands across their chest to reduce the risk of injury
• A disposable sling can be used many times with the same client before it is disposed of
• A shower sling can get wet
• If moving a bilateral above‑knee amputee in a sling, use a specific amputee sling.

Applying a sling using two rolls

1. Place a pillow under the client’s head
2. Select the correct sling; for example, the client’s head may need supporting
3. Roll the client on to their side, roll the same half of the sling and place along spine lengthwise behind them, position from base of the spine upwards
4. Roll the client back the other way, so now they are on one half of the sling
5. Unroll the rest of the sling, then roll the client back on to their back
6. Check that the client is correctly positioned on the sling, ready for hoisting
7. You may need to adjust the head support for comfort.

Applying a sling using one roll

1. Roll the client on to their side
2. Fold sling in half with labels and handles on the outside
3. Position sling from the base of the spine upwards
4. If the sling has a neck seam, align seam with base of client’s neck
5. There should be a gap between the sling and the client’s body so that when they roll back their spine is in the middle of the sling
6. Take upper leg strap and feed the loop under the client’s neck
7. Fold the upper shoulder loop/clip into the sling and roll entire upper portion of sling into space behind client’s back. Roll client on to back
8. Take the loop or clip from under client’s neck and pull smoothly towards you and down in the direction of the legs using a lunge; the sling should unroll underneath the client
9. Both carers pull the sling towards themselves to remove the creases
10. You may need to adjust the head support for comfort.

Applying a sling to a client in a chair

1. Instruct the client to lean forward in the chair
2. Slide the sling down the back of the chair with the handles facing the back of the chair
3. If client cannot lean forward or is in a moulded chair, slide one slide sheet down their back and slide the sling in behind that to reduce friction and any damage to the skin
4. Ensure the bottom of the sling reaches the base of the spine. Remove slide sheets once the sling is in place. Do not have the client sit on the sling as they will drop lower during hoisting, which can be frightening and unsafe. Some slings have a pocket on the lower back that allows the carer to place a flat hand in it and position the sling appropriately
5. Put the leg straps under each leg one at a time. If the client is unable to lift their leg, either use a slide sheet to help slide the strap under or kneel in front of the client and place their foot on your thigh – this should ease the strap application
6. Bring hoist to the client, adjusting hoist legs to widen around the chair, and attach the sling to the sling bar preferably at sternum (chest) level
7. Ensure the sling bar is held and watched continuously so that it does not swing into the client’s face
8. Hoist the client just high enough to be off the chair and encourage them to move slightly – this will alert the carer to any disscomfort and enhance the client’s confidence in the hoist. Check sling loops again at this point to ensure they are all on safely
9. Complete the hoisting process.

Applying a sling to a client on the floor
1.Roll client on to their side and position sling
2.Fold the upper loop into sling and roll upper portion of sling behind client’s back
3.Push rolled half of sling under client
4.Roll client flat on their back and pull through rolled half of sling
5.Straighten each side of sling and locate loops
6.Ask client to bend their knees and pull loops through legs and across front.

Parts of a mobile hoist include:

• Boom (goes up and down)
• Sling bar, spreader bar or yoke.
• Legs (move in and out)
• Mast – upright part of hoist
• Handles – for manoeuvring the hoist
• Brakes – only to be used for storage. Do not use brakes when hoist is in use as the hoist needs to find its own centre of gravity, otherwise it may tip over
• Emergency stop button (if hoist is not working, check it is not pushed in)
• Emergency lower buttons (you may need extra pressure to come down on older hoists)
• Weight limit (SWL)
• Maintenance alert – do not use if out of date.

Watch

The following videos provide demonstrations of:

Using Lifters

How to use a stand up life - Aged Care manual handling technique tutorial

Applying a sling

Transferring a person between a bed and a chair

Transferring a person from seated to standing with one support person

Transferring a person in and out of car

Based on a persons individualised plan you will know whether they need assistant in moving around. This may include from wheelchair to car, from walking frame to car or from bed to chair and vice versa.
The clients individualised plan will also detail the equipment and aids that need to be available to them. Prior to assisting a client you must undertake a risk assessment, the purpose of this is to keep both the workers and the clients safe.
To transfer a person from a vehicle to a walking frame you should follow these steps (this transfer would require one worker and one slide sheet)

1. Slide the car seat back as far as it will go to allow maximum space to lift the legs out
2. Check the seat back is fully upright
3. Ensure the client’s walker is close by but out of the carer’s way
4. Ask the client to lift their legs out of the car. It is generally easier to move in small movements and move one leg at a time. If they have difficulty doing this, you can place a scrunched‑up slide sheet under the buttocks to reduce friction
5. Get them to move forward until their feet are flat on the ground
6. The client will need to hold on to something as they stand. They can push using the car seat or backrest. Alternatively, wind the window down and the client can use the door for support while the carer uses their body weight to prop the door for safety*
7. Once standing, the client transfers their hands to the walker (with brakes applied)
8. If they are unable to stand and step around, another technique or aid should be considered. This will require the client to be referred to a therapist and have a technique tailored to them.

Watch

The following video provides instructions for getting a client into a car safely.

Seeking supervisor support can be an important step in addressing any concerns or issues that may arise in the course of providing care and support to older adults, particularly if there are requirements or client needs that are outside the scope of your work role. Your direct supervisor is usually the first point of call when you are reaching out for support.

Some ways to seek supervisor support include:

• Clearly and directly express the concern or issue that is being experienced, and provide any relevant information or documentation that supports the concern.
• Consider possible solutions to the problem and present them to the supervisor. This shows that you have thought about the problem and have attempted to find a solution.
• Be open to feedback from the supervisor and be willing to consider different perspectives.
• Remain professional and respectful in all interactions with the supervisor, regardless of the outcome of the discussion.
• Document the conversation with the supervisor in case further follow-up is needed.
• Follow up with the supervisor to ensure that the issue has been addressed or to check on the progress of any actions taken.

Your supervisors are there to support and guide you, and seeking their support is a normal and important aspect of your role.

Practices that support skill maintenance and development

Skills maintenance and development is an ongoing process and requires commitment, dedication, and a willingness to continuously learn and grow. There are several practices that can support you to maintain and continue to develop your skills.

This can include:

• Continuing education and training programs can help you stay up-to-date with the latest industry developments, regulations, and best practices.
• Supervision and mentoring can provide aged care professionals with feedback, guidance, and support to help them develop and maintain their skills.
• Collaborating and working in teams with other aged care professionals can provide opportunities for skill sharing, learning, and problem-solving.
• Reflecting on one's own performance and seeking feedback from colleagues and supervisors can help identify areas for skill development and improvement.
• Developing and implementing a professional development plan can help set goals and track their progress in developing and maintaining their skills.
• Opportunities for practice-based learning, such as shadowing, job rotation, and simulation, can provide hands-on experience and help professionals to apply their skills in real-world situations.
• Attending conferences, workshops and seminars can provide opportunities to learn new skills and network with other professionals, and can help to keep you up-to-date with the latest research and best practices.