Is your model of care an enabler or disabler?

In Australia, aged care and disability organisations provide support for people who are unable to perform tasks for themselves as a result of disability or the ageing process. I believe there is a vast difference between passive care that can further disable a person – and active care that enables the person. Providing passive care involves a care giver giving care to a recipient, which can result in further disabling of the recipient as they become more and more dependent on the care giver.

Providing active care, on the other hand, can be likened to providing a service, where the person with a disability or who is ageing (‘the client’) is actively encouraged and equipment and support are provided so they can do as much as possible for themselves. This enablesthe client, as the support worker only assists where the client is unable to complete the task themselves.

The five mistakes made that contribute to disabling support services and how enabling care can be created.

Mistake 1: Generic care services are provided

The care plan is often based on a brief discussion with the client based on what they can and can’t currently do for themselves and relies on the existing care environment and equipment available. The support worker has been given a list of what to do and often ends up doing more than is necessary for the client, which gradually reduces the client’s functional abilities. Thus disables the client long-term.

Principle 1. Engage a health professional who has expertise to conduct a thorough care needs assessment to provide tailored care.

A health professional with specialist expertise in manual handling, understanding a clients diagnosis and how this impacts on their abilities, along with knowledge of up to date aids, equipment and home environment modifications, is ideal. They can provide recommendations on how to maximise a person’s functional abilities through prompting, setting up the tasks in a different way, using equipment to enable the client, so the care can be completed comfortably and safely for both parties and importantly in an engaging way for the client.

Mistake 2: Relying on the support worker to ‘fill the gaps’.

When a client is unable to perform a task, the default solution is for the support worker to provide assistance – that is, they ‘fill the gaps’ of what the client is unable to do. This increases the physical assistance provided and thus disables the client. It also requires the support worker to do more than is necessary and thus increases the risk of sustaining a manual handling injury.

Principle 2. Use equipment that enables a client to be able to do more independently.

It can be as simple as a long handled sponge and shower hoses to clean hard to reach areas, a shower chair to sit on and providing a shower caddy or a self dispensing unit on the wall so the client can reach their showering items for themselves. Slippery sheets on the bed and a bed rail can enable the client to turn themselves over. I could write 100’s of blogs just on equipment itself!

This equipment can be recommended from a care needs assessment as outlined in principle 1. The organisations manual handling training program should also expose support workers the latest innovative equipment that can enable clients and minimise physical assistance by the support workers. This training should be provided by a health professional with expertise in manual handling and risk management, as outlined in Principle 1. This way you equip support workers with the knowledge and skills to be able to identify equipment that could enable a client in all their care routines they attend to.

Mistake 3: There is no effective system in place within the care organisation for reporting issues or potential problems.

Often, support workers may see risks or ways to improve a service, however, don’t want to appear to be whining or to ruin their relationship with the person receiving the service by reporting these issues to their manager. In some cases, there is a system, but support workers advise that when they report an issue, nothing happens. As a result, support workers feel discouraged from reporting risks and potential improvements and the service remains disabling or risky.

Principle 3: There is a clear, easy reporting system that enables support workers to report problems, near misses and suggestions to improve care.

Clients, support workers and management are trained in this process so that issues are reported promptly and management reacts efficiently and effectively. This acts as positive reinforcement so that workers and clients continue to report issues and the organisation and care services continue to improve. This is what creates exceptional quality care. In the changing and every increasingly challenges care environment, this is how your organisation can differentiate itself in the marketplace. Positioning your organisation as a provider of choice for both employees and clients.

Mistake 4: There is no documented, tailored care plan.

Often, support workers rely on being told about the client’s care needs by another support worker or only have access to limited information. Care services are therefore provided inconsistently and differently, depending on which support worker is on duty. This is confusing for the client, can disable them and also result in behaviours of concern, particularly in relation to dementia, intellectual disability or brain injury.

Principle 4. Each care organisation has a system for assessing and documenting a client’s care needs, so that:

  1. a highly tailored care plan can be developed.

This is written in simple, easy to understand language. Step by step instructions with photos demonstrate key features of equipment, how to set up the task and how to prompt the client to enable them to complete as much of the task as possible.

2.  manual handling risks can be identified and controlled for the support worker, to make their job easier and safer.

Support workers, including casual staff, are provided with task-specific training based on these plans. Charts and diagrams at strategic places help to remind staff of safe and effective work practices, but they are not a substitute for specific training.

Mistake 5: The care needs of a client are not reviewed regularly.

Often, care continues for years without anyone being aware of a change in the status of the person receiving care. For example, their function may have deteriorated or may in fact have improved. Alternatively, new equipment or techniques may become available, however no one is aware of this and thus care remains constant with risks and disabling practise continuing to occur rather than taking advantage of advances in equipment, technology or work practices.

Principle 5: Regular reviews of the client’s care needs occur.

The system outlined in Principle 4 can facilitate care need reviews when required. These are completed by a person with expertise as outlined in Principle 1. This ensures care continues to maximise the clients abilities and minimise the risk of manual handling injuries for Support Workers. A system of reviewing a clients care needs on a yearly basis or other set timeframe can also assist.

In summary, care that is enabling and engaging for the client with a disability or who is ageing means exceptional quality care. Exceptional quality care can occur with the framework of the ‘right equipment’, the ‘right expertise’ and the ‘right education’. These are all principles of “SmartCare” and should be incorporated into a care provider’s manual handling training, assessment of care needs and risk management systems. In addition, a highly effective system and procedures that facilitates assessment and development of tailored, individualised care plans with regular reviews to accommodate for any changes in the person’s abilities during their personal care tasks. Its all about enabling rather than disabling clients abilities.

If you would like further resources or support to provide enabling exceptional care then jump onto our website give us a call on 0429 841 049. We love what we do. Here’s to life, freedom & happiness for all.


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