Manual handling issues with people with disabilities
When working in the care and disability industry, many people only associate manual handling challenges in relation to people living with physical disabilities. We have long been aware of the need to lift a person out of bed, assisting to shower and perhaps get into their wheelchair to start their day.
But manual handling can be an even bigger issue when working with a person with an intellectual disability.
What about those with intellectual disabilities?
Like many people, I wasn’t aware of the manual handling issues involved in caring for people living with intellectual disabilities. Then I began to work with many clients, or ‘participants’ as they are referred to by NDIS, living with intellectual disability. I witnessed first-hand so many manual handling risks and the adverse effects on all of those involved.
Clearly, there is a huge need for manual handling risk assessment and training when working with people with intellectual disabilities.
Let’s take a look at an example of how supporting someone with an intellectual disability requires the support worker to provide physical assistance and therefore are exposed to manual handling risks and what this means for all stakeholders.
John (not his real name) has a significant intellectual disability, is unsteady on his feet, is unable to verbally communicate and thus exhibits behaviours to demonstrate his preferences and dislikes. He loves riding in the bus to look around his community and attend his day program, but predictably, he dislikes disembarking at the end of the day and so and avoids this at all cost. The things he enjoys and is engaged in are over and John refuses to leave the bus at the end.
Exiting the bus
John is dropped off at his home by the bus that drops a number of clients to different homes and therefore needs John to exit in a timely manner so it can return other clients to their homes.
To date, two strategies have been tried:
- Firstly, if John is left in the bus he will eventually leave of his own volition after an hour or so of sitting alone in the bus. Obviously, this isn’t an option as the driver needs to deliver other clients home and return the bus to its base and besides, support workers are reluctant to leave John unsupervised in the bus. John can fall down the steps an injure himself.
- Secondly, the driver and two support workers in John’s home physically lift John out through the side door of the van. The issues that this brings for John, the support workers, the driver and the care organisation are bigger than Ben Hur. They are so much more than just the manual handling risks. Let’s take a look at them.
- Manual handling: The driver of the vehicle injured his back and his organisation now has the exhausting process of assisting an injured worker to return to work, covering shifts with casuals, costs associated with training and employing casuals, unplanned escalating workers compensation insurance premiums, time and stress for management to manage the arduous return to work process. And that’s just the injury.
- Legal issues:The care organisation can be found to be not meeting their legislative requirements under the Workplace Health and Safety Act. They have a duty of care to the Support Workers to provide a safe workplace, work procedure and adequate training to manage these risks. The care organisation has a duty of care and obligations to ensure John is not injured and that they meet restrictive practice requirements. That is, not restrict John against his will.
- Reputation:Unfortunately, helping John to exit the bus occurs on a daily basis on a residential street with neighbours and onlookers watching the distressing process. What impact does this have on the care organisation’s reputation in the community? What impact does this have on the care organisation being able to position itself as a provider and employer of choice?
- Retention of Support Workers:The support workers are doing the best job that they can with their knowledge, skills and capacity. They experience aches and pains, are stressed and are concerned that John may become injured. Understandably, support workers want to avoid this task of removing John. They don’t know of any better alternatives and many want to avoid this particular shift altogether. Finding the right support workers for the job is difficult in relation to recruitment and retention.
- John:And let’s not forget about why there is a care service in the first place. It’s to support John to attain his goals under his NDIS plan, to choose to engage in daily living tasks he enjoys. John is frustrated as he’s unable to communicate verbally and as a result exhibits challenging behaviour to communicate his preferences. The manner in which John exits the vehicle is not comfortable, dignified or safe. John is being disabled rather than enabled and is not building on his living skills and independence.
It’s a really tough situation.
Working towards a solution – so it’s a win-win for everyone
So how can quality care be facilitated that’s a win-win for all stakeholders? Not just for John, but for thousands of people living with an intellectual disability who require personal care and support services?
Principles of quality care
There are five principles that can be implemented to establish a quality care solution for people in a similar situation as John. These include:
- Conducting a manual handling risk assessment with a specialist manual handling consultant.This identifies the hazards and prioritises the risk in terms of urgency. Recommendations are made around how the Care Organisation can minimise the risk of injury for both the Support Workers and John in the interim and long-term.
- An integrated approach between behavioural management support and manual handling.One impacts on the other, so an integrated, multi-disciplinary approach is required. Engaging a behavioural specialist shall provide expertise in understanding how to meet John’s needs to minimise behaviour that challenges in the first instance. When challenging behaviour is minimised so too is the manual handling risks and John’s choice and control maintained.
- A clear client care planoutlining recommendations including behavioural management strategies and recommendations to minimise the manual handling risks. This needs to be outlined in easy to understand language and steps for Support Workers to review as many times as they need to, to understand how to provide the support and minimise behaviour and risk.
- Provision of behavioural and task specific manual handling trainingwith the support workers to increase their confidence, support options and skills. Training engages the Support Workers to gain the knowledge and experience to implement the client care plan successfully.
- Regular review with support workers and Johnto ensure that the strategies and care plan are working successfully. This ensures consultation and that the risk management strategies are working and ultimately ensures your organisation is meeting legislative requirements under the WHS act.
Providing quality care for people living with intellectual disabilities often necessitates sound manual handling and behavioural strategies. Getting the right expertise, right processes and right training helps create a win-win for all stakeholders to facilitate exceptional quality care.
I would love to hear other people’s experiences and opinions and how we can create a win win for all stakeholders experiencing these challenging care experiences.