Examples of physical disablers in aged care

CHCAGE001

FACILITATE THE EMPOWERMENT OF OLDER PEOPLE

LEARNER RESOURCE

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T A B L E O F C O N T E N T S

TABLE OF CONTENTS ........................................................................................................................................ 1

COURSE INTRODUCTION .................................................................................................................................. 4

ABOUT THIS GUIDE ..................................................................................................... ERROR! BOOKMARK NOT DEFINED. ABOUT THIS RESOURCE ...................................................................................................................................... 4 ABOUT ASSESSMENT .......................................................................................................................................... 5

ELEMENTS AND PERFORMANCE CRITERIA ....................................................................................................... 7

PERFORMANCE EVIDENCE AND KNOWLEDGE EVIDENCE ................................................................................. 9

PERFORMANCE EVIDENCE ......................................................................................................................................... 9 KNOWLEDGE EVIDENCE ............................................................................................................................................ 9

ASSESSMENT CONDITIONS ............................................................................................................................ 11

PRE-REQUISITES ............................................................................................................................................. 11

TOPIC 1 – DEVELOP RELATIONSHIPS WITH OLDER PEOPLE............................................................................. 12

CONDUCT INTERPERSONAL EXCHANGES IN A MANNER THAT PROMOTES EMPOWERMENT AND DEVELOPS

AND MAINTAINS TRUST AND GOODWILL ...................................................................................................... 12

RECOGNISE AND RESPECT OLDER PEOPLE’S SOCIAL, CULTURAL AND SPIRITUAL DIFFERENCES ...................... 15

MAINTAIN CONFIDENTIALITY AND PRIVACY OF THE PERSON WITHIN ORGANISATION POLICY AND

PROTOCOLS ................................................................................................................................................... 18

DUTY OF CARE REQUIREMENTS ................................................................................................................................. 18 ORGANISATIONAL CODE OF CONDUCT ........................................................................................................................ 18 ORGANISATIONAL REQUIREMENTS ............................................................................................................................ 19 PRIVACY .............................................................................................................................................................. 20

ENCOURAGE THE PERSON TO ADOPT A SHARED RESPONSIBILITY FOR OWN SUPPORT AS A MEANS OF

ACHIEVING BETTER HEALTH OUTCOMES AND QUALITY OF LIFE..................................................................... 21

TOPIC 2 – PROVIDE SERVICES TO OLDER PEOPLE ........................................................................................... 23

IDENTIFY AND DISCUSS SERVICES WHICH EMPOWER THE OLDER PERSON AND SUPPORT THE OLDER PERSON

TO EXPRESS THEIR OWN IDENTITY AND PREFERENCES WITHOUT IMPOSING OWN VALUES AND ATTITUDES 23

EXPLAIN THE SCOPE OF SERVICE ............................................................................................................................... 25

ADJUST SERVICES TO MEET THE SPECIFIC NEEDS OF THE OLDER PERSON AND PROVIDE SERVICES ACCORDING

TO THE OLDER PERSON’S PREFERENCES ........................................................................................................ 27

ACCESS AND EQUITY ............................................................................................................................................... 27 WHAT IS PERSON-CENTRED PRACTICE? ...................................................................................................................... 27 WHY IS PERSON-CENTRED PRACTICE IMPORTANT? ....................................................................................................... 28 CREATION OF A CLIENT ORIENTATED CULTURE AND A NON-DISCRIMINATORY APPROACH TO ALL INDIVIDUALS USING OR ACCESSING

THE SERVICE ......................................................................................................................................................... 29 RESPECT FOR INDIVIDUAL DIFFERENCES ...................................................................................................................... 29

PROVIDE SERVICES ACCORDING TO ORGANISATION POLICIES, PROCEDURES AND DUTY OF CARE

REQUIREMENTS ............................................................................................................................................. 31

POLICIES AND PROCEDURES ..................................................................................................................................... 31

TOPIC 3 – SUPPORT THE RIGHTS OF OLDER PEOPLE ....................................................................................... 34

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ASSIST THE OLDER PERSON TO UNDERSTAND THEIR RIGHTS AND THE COMPLAINTS MECHANISMS OF THE

ORGANISATION ............................................................................................................................................. 34

COMPLAINTS ........................................................................................................................................................ 35 AGED CARE COMPLAINTS SCHEME ........................................................................................................................... 35

DELIVER SERVICES ENSURING THE RIGHTS OF THE OLDER PERSON ARE UPHELD AND IDENTIFY BREACHES OF

HUMAN RIGHTS AND RESPOND APPROPRIATELY .......................................................................................... 37

INTERNATIONAL FEDERATION OF AGEING DECLARATION ON THE RIGHTS AND RESPONSIBILITIES OF OLDER PERSONS ................ 37 INDEPENDENCE ..................................................................................................................................................... 37 PARTICIPATION ..................................................................................................................................................... 38 CARE .................................................................................................................................................................. 38 SELF - FULFILMENT ................................................................................................................................................ 39 DIGNITY .............................................................................................................................................................. 39

RECOGNISE SIGNS CONSISTENT WITH FINANCIAL, PHYSICAL OR EMOTIONAL ABUSE OR NEGLECT OF THE

OLDER PERSON AND REPORT TO AN APPROPRIATE PERSON ......................................................................... 41

DEFINITION .......................................................................................................................................................... 41 FORMS OF ABUSE ................................................................................................................................................. 41 PHYSICAL ABUSE ................................................................................................................................................... 42 SEXUAL ABUSE ..................................................................................................................................................... 42 FINANCIAL ABUSE .................................................................................................................................................. 43 PSYCHOLOGICAL/ EMOTIONAL ABUSE ....................................................................................................................... 44 SOCIAL ABUSE ...................................................................................................................................................... 44 NEGLECT ............................................................................................................................................................. 45

ASSIST THE PERSON TO ACCESS OTHER SUPPORT SERVICES AND THE COMPLAINTS MECHANISMS AS

REQUIRED ...................................................................................................................................................... 47

LODGING A COMPLAINT WITH THE AGED CARE COMPLAINTS SCHEME ............................................................................. 47 WHAT CAN YOU COMPLAIN ABOUT? ......................................................................................................................... 47 WHO CAN MAKE A COMPLAINT? .............................................................................................................................. 47 WHAT TYPES OF SERVICES ARE COVERED BY THE SCHEME? ............................................................................................ 48 WHAT HAPPENS AFTER YOU LODGE A COMPLAINT? ...................................................................................................... 48

TOPIC 4 – PROMOTE HEALTH AND RE-ABLEMENT OF OLDER PEOPLE ............................................................ 49

ENCOURAGE THE OLDER PERSON TO ENGAGE AS ACTIVELY AS POSSIBLE IN ALL LIVING ACTIVITIES AND

PROVIDE THEM WITH INFORMATION AND SUPPORT TO DO SO AND ASSIST THE OLDER PERSON TO

RECOGNISE THE IMPACT THAT CHANGES ASSOCIATED WITH AGEING MAY HAVE ON THEIR ACTIVITIES OF

LIVING ........................................................................................................................................................... 49

AGE-RELATED CHANGES ......................................................................................................................................... 51 MUSCLE AND BONE CONDITIONS IN OLDER AGE ........................................................................................................... 51 AGE-RELATED CHANGES IN MUSCLE .......................................................................................................................... 51 AGE-RELATED CHANGES IN BONE .............................................................................................................................. 52 AGE-RELATED CHANGES IN JOINTS ............................................................................................................................ 52 PHYSICAL ACTIVITY CAN HELP ................................................................................................................................... 52 TYPICAL PHYSICAL CHANGES ................................................................................................................................... 53

IDENTIFY STRATEGIES AND OPPORTUNITIES THAT MAXIMISE ENGAGEMENT AND PROMOTE HEALTHY

LIFESTYLE PRACTICES AND WORK WITH THE PERSON TO IDENTIFY PHYSICAL AND SOCIAL ENABLERS AND

DISABLERS IMPACTING ON HEALTH OUTCOMES AND QUALITY OF LIFE ......................................................... 57

PROMOTING INDEPENDENCE AND AUTONOMY ............................................................................................................ 57 PURPOSEFUL ACTIVITIES ......................................................................................................................................... 59 WHAT NEW INTERESTS COULD BE INTRODUCED? ......................................................................................................... 61 BENEFITS OF HEALTHY ACTIVITIES ............................................................................................................................. 62

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IDENTIFY AND UTILISE AIDS AND MODIFICATIONS THAT PROMOTE INDIVIDUAL STRENGTHS AND CAPACITIES

TO ASSIST WITH INDEPENDENT LIVING IN THE OLDER PERSON’S ENVIRONMENT ......................................... 63

DISCUSS SITUATIONS OF RISK OR POTENTIAL RISK ASSOCIATED WITH AGEING ............................................ 66

SECURITY SYSTEMS ................................................................................................................................................ 67 SHELTER AND PROTECTION ...................................................................................................................................... 67 COMFORT AND SELF EXPRESSION .............................................................................................................................. 67 SAFETY AND ADAPTATIONS ...................................................................................................................................... 68 RECOGNISING HAZARDS .......................................................................................................................................... 69 ASSESSING HAZARDS .............................................................................................................................................. 69 SEVERITY ............................................................................................................................................................. 70 ANALYSING THE LIKELIHOOD AND CONSEQUENCES OF RISK ............................................................................................ 70 HAZARD RATING MATRIX CHART ............................................................................................................................... 71 REPORTING RISKS AND HAZARDS .............................................................................................................................. 71

PALLIATIVE CARE ........................................................................................................................................... 72

SUMMARY ..................................................................................................................................................... 73

REFERENCES ................................................................................................................................................... 74

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U N I T I N T R O D U C T I O N

This resource covers the unit CHCAGE001 - Facilitate the empowerment of older people.

This unit describes the skills and knowledge required to respond to the goals and aspirations of older people and provide support services in a manner that focuses on improving health outcomes and quality of life, using a person-centred approach.

This unit applies to support workers in residential or community contexts.

The skills in this unit must be applied in accordance with Commonwealth and State/Territory legislation, Australian/New Zealand standards and industry codes of practice.

ABOUT THIS RESOURCE

This resource brings together information to develop your knowledge about this unit. The information is designed to reflect the requirements of the unit and uses headings to makes it easier to follow.

Read through this resource to develop your knowledge in preparation for your assessment. You will be required to complete the assessment tools that are included in your program. At the back of the resource are a list of references you may find useful to review.

As a student it is important to extend your learning and to search out text books, internet sites, talk to people at work and read newspaper articles and journals which can provide additional learning material.

Your trainer may include additional information and provide activities. Slide presentations and assessments in class to support your learning.

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ABOUT ASSESSMENT

Throughout your training we are committed to your learning by providing a training and assessment framework that ensures the knowledge gained through training is translated into practical on the job improvements.

You are going to be assessed for:

 Your skills and knowledge using written and observation activities that apply

to your workplace.

 Your ability to apply your learning.

 Your ability to recognise common principles and actively use these on the job.

You will receive an overall result of Competent or Not Yet Competent for the assessment of this unit. The assessment is a competency based assessment, which has no pass or fail. You are either competent or not yet competent. Not Yet Competent means that you still are in the process of understanding and acquiring the skills and knowledge required to be marked competent. The assessment process is made up of a number of assessment methods. You are required to achieve a satisfactory result in each of these to be deemed competent overall.

All of your assessment and training is provided as a positive learning tool. Your assessor will guide your learning and provide feedback on your responses to the assessment. For valid and reliable assessment of this unit, a range of assessment methods will be used to assess practical skills and knowledge.

Your assessment may be conducted through a combination of the following methods:

 Written Activity

 Case Study

 Observation

 Questions

 Third Party Report

The assessment tool for this unit should be completed within the specified time period following the delivery of the unit. If you feel you are not yet ready for assessment, discuss this with your trainer and assessor.

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To be successful in this unit you will need to relate your learning to your workplace. You may be required to demonstrate your skills and be observed by your assessor in your workplace environment. Some units provide for a simulated work environment and your trainer and assessor will outline the requirements in these instances.

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E L E M E N T S A N D P E R F O R M A NC E C R I T E R I A

1. Develop relationships with older people

1.1 Conduct interpersonal exchanges in a manner that promotes empowerment and develops and maintains trust and goodwill

1.2 Recognise and respect older people’s social, cultural and spiritual differences

1.3 Maintain confidentiality and privacy of the person within organisation policy and protocols

1.4 Work with the person to identify physical and social enablers and disablers impacting on health outcomes and quality of life

1.5 Encourage the person to adopt a shared responsibility for own support as a means of achieving better health outcomes and quality of life

2. Provide services to older people

2.1 Identify and discuss services which empower the older person

2.2 Support the older person to express their own identity and preferences without imposing own values and attitudes

2.3 Adjust services to meet the specific needs of the older person and provide services according to the older person’s preferences

2.4 Provide services according to organisation policies, procedures and duty of care requirements

3. Support the rights of older people

3.1 Assist the older person to understand their rights and the complaints mechanisms of the organisation

3.2 Deliver services ensuring the rights of the older person are upheld

3.3 Identify breaches of human rights and respond appropriately

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3.4 Recognise signs consistent with financial, physical or emotional abuse or neglect of the older person and report to an appropriate person

3.5 Assist the person to access other support services and the complaints mechanisms as required

4. Promote health and re- ablement of older people

4.1 Encourage the older person to engage as actively as possible in all living activities and provide them with information and support to do so

4.2 Assist the older person to recognise the impact that changes associated with ageing may have on their activities of living

4.3 Identify strategies and opportunities that maximise engagement and promote healthy lifestyle practices

4.4 Identify and utilise aids and modifications that promote individual strengths and capacities to assist with independent living in the older person’s environment

4.5 Discuss situations of risk or potential risk associated with ageing

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P E R F O R M A N C E E V I D E N C E A N D K N O W L E D G E E V I D E N C E

This describes the essential knowledge and skills and their level required for this unit.

PERFORMANCE EVIDENCE

The candidate must show evidence of the ability to complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the job role. There must be evidence that the candidate has:

 Responded to the goals and aspirations of at least 2 older people, 1 in a

simulated environment and 1 in the workplace:

 Employing flexible, adaptable and person-centred approaches to empower

the individual

 Recognising and responding appropriately to situations of risk or potential

risk

 Used oral communication skills to maintain positive and respectful

relationships

KNOWLEDGE EVIDENCE

The candidate must be able to demonstrate essential knowledge required to effectively complete tasks outlined in elements and performance criteria of this unit, manage tasks and manage contingencies in the context of the work role. This includes knowledge of:

 Structure and profile of the aged care sector:

o Residential aged care sector

o Home and community support sector

o Current best practice service delivery models

o Relevant agencies and referral networks for support services

 Key issues facing older people, including:

o Stereotypical attitudes and myths

o The impact of social devaluation on an individual’s quality of life

 Implications for work in the sector, including:

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o Concepts of positive, active and healthy ageing

o Rights-based approaches

o Person-centred practice

o Consumer directed care

o Palliative approach

o Empowerment and disempowerment

o Re-ablement and effective re-ablement strategies

 The ageing process and related physiological and psychological changes,

including sexuality and gender issues

 Strategies that the older person may adopt to promote healthy lifestyle

practices

 Legal and ethical considerations for working with older people, including:

o Codes of practice

o Discrimination

o Dignity of risk

o Duty of care

o Human rights

o Privacy, confidentiality and disclosure

o Work role boundaries – responsibilities and limitations

o Work health and safety

 Indicators of abuse and/or neglect, including:

o Physical

o Sexual

o Psychological

o Financial

 Reporting requirements for suspected abuse situations

 The impact of own attitudes on working with older people

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A S S E S S M E N T C O N D I T I O N S

All aspects of the performance evidence must have been demonstrated using simulation prior to being demonstrated in the workplace. The following conditions must be met for this unit:

 Use of suitable facilities, equipment and resources, including:

 Relevant organisation policies and procedures

 Relevant aids to assist with independent living

Assessors must satisfy the Standards for Registered Training Organisations (RTOs) 2015/AQTF mandatory competency requirements for assessors.

P R E - R E Q U I S I T E S

This unit must be assessed after the following pre-requisite unit:

There are no pre-requisites for this unit.

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T O P I C 1 – D E V E L O P R E L A T I O N S H I P S W I T H O L D E R P E O P L E

CONDUCT INTERPERSONAL EXCHANGES IN A MANNER THAT PROMOTES EMPOWERMENT AND DEVELOPS AND MAINTAINS

TRUST AND GOODWILL

The older person’s willingness and ability to direct the processes relating to the provision of their care may be attributed to both how well informed they are and a recognition that they have the right to refuse services.

In order to exercise choice and maximise independence, people require access to accurate information that will help them manage their own lives, understand their options and engage with and actively participate in their community.1

The client has the power to determine the direction that their care takes. Those providing support services should not presume what direction their care will take. As it is the older person who makes the ultimate decision regarding the provision of their care and services, they are the person who is providing direction to the support worker.

Whilst the support person can provide the client with information and suggestions which they feel may be beneficial to their care, the older person has the right to refuse these suggestions and choose the path they wish to take. They may wish to determine their ongoing care on a daily basis or institute planning for their needs in the future. In the case where the support worker identifies potential issues in the way the care in being planned or instituted then they may wish to raise this with the client, but ultimately they need to respect the client’s decision.

Providing information to the older client may assist them in making decisions about how they may improve their lifestyle. The information needs to be relevant to their needs and lifestyle, how improvements might be made, and should identify the services which could be of assistance to them in meeting their needs. This information may be in relation to issues such as the provision of health care services, equipment which might be beneficial to them, financial services or perhaps referrals that might provide them

1 http://www.adhc.nsw.gov.au/individuals/support/directing_my_own_life

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with the further information they need. Providing this information enable the individual to gain a better sense of control over their life.

If the older person is not given the responsibility of directing their care, then there is a risk that they will become compliant with the direction of the person or organisation providing the services. Subsequently, this can negatively impact upon their independence. In this situation, the provision of care and services is directed by the provider and the older person risks losing their sense of empowerment. Whilst the support worker may be compliant with respect to the provision of care and services, the overall effect may be detrimental to the older person in that they can become reliant on others making decisions for them.

There may be compliance issues arise when the support worker who is in a position of influence promotes what they see as being beneficial to the client. If the worker promotes their ideas in such a way that they are perceived to be insistent of intimidating to the older person, then this may result in the older person feeling disempowered and having to do what they are told.

A more appropriate way of approaching the client regarding the way in which they utilise a particular service would be to explain not only what services are available to them but how they might be beneficial. i.e. there should be reasoning behind the suggestions given.

If the support worker identifies the need for an intervention which will be of benefit to the client, and the client subsequently refuses, then there should be supporting documentation outlining the refusal as well as the reasoning behind the refusal. Instances of non-compliance without the appropriate supporting reasoning can sometimes be viewed as the client being merely obstinate or irrational. Providing the reasoning behind their choice to refuse the implementation of services can assist in validating their decision.

The older person may wish to consult with an advocate before making a decision based on the suggestions of a support worker.

Advocacy services support people to actively participate in decision making processes and conversations that impact on their lives.

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Advocates will listen and act in the best interests of the individual and support people with the aim to increase independence and confidence to represent their own interests, and help them to be aware of the different ways they can have a say.2

2 http://www.adhc.nsw.gov.au/individuals/support/directing_my_own_life

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RECOGNISE AND RESPECT OLDER PEOPLE’S SOCIAL, CULTURAL AND SPIRITUAL DIFFERENCES

Older people from culturally and linguistically diverse (CALD) backgrounds are a significant and growing section of the older population. In some areas, they comprise the majority of users of community care services. They bring a diversity of experience to older age shaped by cultural attitudes, family roles and responsibilities, and beliefs about health and disability. Also relevant are factors such as length of time since arriving in Australia, reasons for migration, post-migration experiences, and English language proficiency. These in turn influence their expectations and use of community care services.3

It is important that you ensure that you provide a quality service to every older Australian regardless of their diversity of race, cultural, spiritual, or sexual preferences. Every older Australian has the right to be treated equally and receive the services to meet their need. This is not only part of your duty of care, but it is also the law.

In order to be an effective worker in the Community Services Industry (CSI), you must be able to reflect upon and recognise your personal values and attitudes. Being able to identify how you think and feel about certain issues, for instance, those related to older people and people with disabilities will enable you to understand how your personal views might impact on your role as a care worker. Being empathic, unbiased and non- judgemental are essential attributes if you intend to work in the community services field. It is important to understand your personal values and attitudes because it enhances your professionalism and ethical work practice. 4

In all cases you must ensure you consider each of the following when working with aging people:

 Values - Values are part of each person’s belief system. They develop from

rules learnt as we grow up and become internal messages about how we

should behave and what we believe in.

 Attitudes - Attitudes vary in intensity. When we feel strongly about

something they are called values. Attitudes that are less important to us are

called opinions.

 Stereotypes - A stereotype is a simplified image that develops when you

group people together on the basis of a similarity or characteristic.

3 http://www.islhd.health.nsw.gov.au/Carer_Program/Documents/State_documents/Resea... 4 http://www.islhd.health.nsw.gov.au/Carer_Program/Documents/State_documents/Resea...

http://www.islhd.health.nsw.gov.au/Carer_Program/Documents/State_documents/ResearchToPracticeBriefing4-CALD-OlderPeople.pdf
http://www.islhd.health.nsw.gov.au/Carer_Program/Documents/State_documents/ResearchToPracticeBriefing4-CALD-OlderPeople.pdf
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 Diverse values - Views about drug use, culture, sexual preference, politics

and gender roles will always be present in one way or another, so we all need

to be aware of the impact our values have on processes inside and outside of

the workplace. We do not all think about and respond to issues in the same

way!

 False beliefs - Some of these misconceptions of older people and people with

disabilities include:

o Being dependent

o Incapable of contributing to the community

o Unproductive

o Living on the pension

o Being in need of services

o Ending up in nursing homes

o Having poor health

o Being a burden on family

o Being unable to work

 Pre-existing beliefs - As a worker in the CSI, the pre-existing beliefs you may

have could be related to stereotypes that have developed for you around

issues like sexuality, alcohol and other drugs, ageing and disabilities,

independence, health, the rights of people, your idea of health and what it’s

like to be older and/or disabled.

 Work practice and stereotypes - It is important that you explore your

personal beliefs and become more aware of the way you view older people

and people with disabilities. This will assist you in your work to:

o Develop objectivity and avoid stereotyping

o Develop a better understanding of clients as individuals

o Identify individual needs and use a client centred approach

o Encourage clients independence

o Improve communication skills

o Plan and implement services appropriately

o Work professionally and ethically

 Discrimination - As a care worker, you must understand the implications of

anti-discrimination legislation. Every day at work you will be in dealing with

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people from varied backgrounds and different issues. By being aware of the

anti-discrimination guidelines, you will be a more effective worker.

 Being fair and consistent - It is essential that workers be fair and consistent

when working with clients.

 Developing cultural sensitivity - There are a number of steps we can take to

develop cultural sensitivity with clients:

 Identify our attitudes and values before entering the workplace

 Try not to make value judgements about what is right and wrong for other

people

 Communicate and respond to the client in a professional manner regardless

of your opinions about their behaviour and values

 Try to imagine what life is like from the client’s perspective

 Keep in mind that the client has the right to respect and dignity; this includes

respecting their choices

 Enhancing communication - Here are some useful communication tips when

working with clients:

 Don’t rush—be prepared to spend time

 Provide a comfortable environment for the client, interpreter and you the

worker

 Speak in plain English. Use simple phrases. Avoid using jargon

 Show empathy and positive body language—ie use good eye contact, be

relaxed.

 Paraphrase, reflect and summarise to clarify what is being said and

demonstrate your understanding

 Accept your client’s cultural and spiritual practices5

5 http://sielearning.tafensw.edu.au/MCS/CHCAOD402A/chcaod402a_csw/lo/8511/8511_00.htm#ID0E4F

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MAINTAIN CONFIDENTIALITY AND PRIVACY OF THE PERSON WITHIN ORGANISATION POLICY AND PROTOCOLS

When providing support and assistance to the older person, it is imperative that you do so according to the policies and procedures of your organisation. Policies aim to tell workers and people being supported what the service values and how it goes about putting those values into practice.

Most written policies are clear, concise sets of guidelines outlining how that service operates. The policies tell you what management expects will happen in certain situations to support the service’s mission/ philosophy (belief statement). The policies state what practices should be implemented, so work is done efficiently and consistently.

Organisational policies relating to the provision of services may encompass issues such as:

 Duty of care requirements

 Organisational code of conduct

 Organisational requirements

DUTY OF CARE REQUIREMENTS

Organisational policies will incorporate the duty of care requirements, which serve to guide the workers in the delivery of their care. This is to ensure that the client does not incur any harm or injury, particularly as a result of the actions of the worker. Duty of care policies will include ensuring that care and service plans are followed, case notes are followed and acted on as appropriate, and that new entries in relation to the health of the individuals are documented accordingly. Having knowledge of the requirements of the duty of care is instrumental in ensuring that the older person is supported in their independence. It is the responsibility of the worker to be aware and familiar of their requirements in relation to the duty of care.

ORGANISATIONAL CODE OF CONDUCT

Every organisation will have its own code of conduct, which outlines the functions that it intends to perform. Usually, there are statements about the mission, values and commitments of the organisation along with how it is guided in the provision of services. Organisations are guided by a charter of rights and responsibilities. These reflect the legislation that the organisation must abide by, and the types of services that

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are provided. Every type of work that occurs within the organisation will have its own code of conduct specific to that type of work. In some instances, members of that group will be accountable to an external professional body.

ORGANISATIONAL REQUIREMENTS

In addition to duty of care requirements, each organisation will have its own organisational requirements. Tis may vary according to the services that it provides. However, there will be similarities relation to the provision of those services to the clients. Organisational requirements need to be known and understood by the workers in order for them to be able to effectively perform their work.

Your service probably has a policy and procedures manual available to workers containing policies on a range of subjects. Some organisations may refer to these as SOP or Standard Operations and Procedures Manual.

Policies are developed to help you in several ways such as:

 Avoiding hurried or spur of the moment decisions

 Guiding your actions so you are aware of due process

 Ensuring consistency in the way things are done by everyone

 Ensuring consistency in duties is carried on even though someone from the

staff may leave

 Ensuring decisions can be made without consulting everyone else

Generally, policies can help the staff team by:

 Empowering individuals who are able to make decisions with confidence as

they are based on written documentation

 Protecting staff who make decisions and act on established policies

 Helping teamwork and cooperation by collectively establishing common

goals, procedures, and understanding

When commencing work within the community services sector, all employees need to be aware of the policies, protocols and procedures relating to the provision of services

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within their organisation and follow them accordingly in the provision of their care of the client.

PRIVACY

As with respect, the older client should feel that their privacy is maintained at all times. The worker should never divulge any information relating to the client to neighbours or any others with respect to the services they are receiving or any other personal matters. When working in the home, consideration should be given to the fact that conversations can be easily heard by others in the vicinity, so therefore you should limit the volume level of your voice.

Tasks such as answering the phone or collecting and reading of the mail should be left to the client unless otherwise requested to do so.

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ENCOURAGE THE PERSON TO ADOPT A SHARED RESPONSIBILITY FOR OWN SUPPORT AS A MEANS OF ACHIEVING

BETTER HEALTH OUTCOMES AND QUALITY OF LIFE

The older person’s willingness and ability to direct the processes relating to the provision of their care may be attributed to both how well informed they are and a recognition that they have the right to refuse services.

In order to exercise choice and maximise independence, people require access to accurate information that will help them manage their own lives, understand their options and engage with and actively participate in their community.6

The client has the power to determine the direction that their care takes. Those providing support services should not presume what direction their care will take. As it is the older person who makes the ultimate decision regarding the provision of their care and services, they are the person who is providing direction to the support worker.

Whilst the support person can provide the client with information and suggestions which they feel may be beneficial to their care, the older person has the right to refuse these suggestions and choose the path they wish to take. They may wish to determine their ongoing care on a daily basis or institute planning for their needs in the future. In the case where the support worker identifies potential issues in the way the care in being planned or instituted then they may wish to raise this with the client, but ultimately they need to respect the client’s decision.

Providing information to the older client may assist them in making decisions about how they may improve their lifestyle. The information needs to be relevant to their needs and lifestyle, how improvements might be made, and should identify the services which could be of assistance to them in meeting their needs. This information may be in relation to issues such as the provision of health care services, equipment which might be beneficial to them, financial services or perhaps referrals that might provide them with further information they need. Providing this information enable the individual to gain a better sense of control over their life.

If the older person is not given the responsibility of directing their care, then there is a risk that they will become compliant with the direction of the person or organisation providing the services. Subsequently, this can negatively impact upon their

6 http://www.adhc.nsw.gov.au/individuals/support/directing_my_own_life

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independence. In this situation, the provision of care and services is directed by the provider and the older person risks losing their sense of empowerment. Whilst the support worker may be compliant with respect to the provision of care and services, the overall effect may be detrimental to the older person in that they can become reliant on others making decisions for them.

There may be compliance issues arise when the support worker who is in a position of influence promotes what they see as being beneficial to the client. If the worker promotes their ideas in such a way that they are perceived to be insistent and intimidating to the older person, then this may result in the older person feeling disempowered and having to do what they are told.

A more appropriate way of approaching the client regarding the way in which they utilise a particular service would be to explain not only what services are available to them but how they might be beneficial. i.e. there should be reasoning behind the suggestions given.

If the support worker identifies the need for an intervention which will be of benefit to the client, and the client subsequently refuses, then there should be supporting documentation outlining the refusal as well as the reasoning behind the refusal. Instances of non-compliance without the appropriate supporting reasoning can sometimes be viewed as the client being merely obstinate or irrational. Providing the reasoning behind their choice to refuse the implementation of services can assist in validating their decision.

The older person may wish to consult with an advocate before making a decision based on the suggestions of a support worker.

Advocacy services support people to actively participate in decision making processes and conversations that impact on their lives.

Advocates will listen and act in the best interests of the individual and support people with the aim to increase independence and confidence to represent their own interests, and help them to be aware of the different ways they can have a say.7

7 http://www.adhc.nsw.gov.au/individuals/support/directing_my_own_life

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T O P I C 2 – P R O V I D E S E R V I C E S T O O L D E R P E O P L E

IDENTIFY AND DISCUSS SERVICES WHICH EMPOWER THE OLDER PERSON AND SUPPORT THE OLDER PERSON TO EXPRESS THEIR OWN IDENTITY AND PREFERENCES WITHOUT IMPOSING OWN

VALUES AND ATTITUDES

Ageing is a normal part of the life process, and as we age, we need to make plans for the later part of our lives. This includes maintaining health, preparing for retirement, and establishing and maintaining social networks and activities. Whilst we are all individuals and each of us has different needs; there are common influences that are experienced by the ageing person which will have a marked effect upon their lives.

As a person gets older they are influenced by changing factors in their lives in relation to:

 Health

 Cultural background

 Education

 Socioeconomic status

 Social interaction with others

It is important that older people have the opportunity to maintain their established connections and achieve the optimal support to maximise the fulfillment in their lives. Positive ageing involves providing people with the opportunity to continue to make a valuable contribution to the community. It promotes the involvement of senior people and facilitates them maintaining their independence by allowing them to care for themselves as much as possible and enabling them to enjoy the later stages of their lives.

Before discussing the ways in which the older person can be encouraged to access support services, it is important to recognise that engaging these services is often a matter of choice. Because of individual differences, not all people wish to utilise or maximise the services available to them. Some older people may choose to remain fiercely independent, and choose to carry on their lives with as little assistance and support as possible. It is, therefore, pertinent to respect their decisions and only offer support where appropriate. i.e. if a person expresses’ that they don’t wish to participate

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in the use of particular services, then they should not feel that they are being pressured into doing so.

There are many support services for older people provided by community and government agencies. Innovative, sustainable and community-based approaches are required to increase access to support services and extend them beyond the traditionally accepted forms. This may include such things as:

 Pet care

 Home maintenance

 Shopping assistance

 Garden care

 Financial advice

 Financial discounts

 Transportation assistance

 Advocacy support

 Legal advice

 Mobility assistance

 Health support services

 Community support groups

 Aged care facilities

The older person may choose to all some or none of these services. It is the responsibility of the community services worker to promote the availability of the services that they feel might be of benefit to their clients and assist them to link with the services that they see as being of benefit in meeting their needs.

Promoting the utilisation of support services may not always be an easy task. As mentioned some older people may be reluctant to employ the services available. The community service worker may choose to use significant other in the person’s life to communicate the benefits they may experience. Such people may include:

 Family members

 Close friends

 Health professionals

 Advocates

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 Case managers

All people who are significant in the lives of the older person can be instrumental in assisting to encourage the use of available support services.

EXPLAIN THE SCOPE OF SERVICE

If the older person and their advocate, if applicable, are to be encouraged to employ the use of support services, then they must have a clear perspective about what the service actually offers. It is, therefore, necessary that they are provided with clear and understandable information. They need to know what the relevant services provide, in order to identify the benefits.

For the scope of the service to be understood there needs to be a clear path of communication between the community service worker and the client. This means that the worker must employ effective communication skills to convey the information to the intended audience. Because of the diversity of the clients that you are working with there will be instances where there are barriers which may need to be overcome. Barriers may be attributed to;

 Age

 Cultural diversity

 Physiological barriers such as having, speech and visual impairments

 Psychological factors e.g. the development of dementia in older clients

 Resistance to change

The worker must, therefore, use their communication skills and the necessary resources to overcome these obstacles. They may wish to use the services of other professionals to assist them with their communication needs, or they may choose to use the persons advocate to assist them in relaying the information to the client. The advocate is generally someone who has an established rapport with the client. This may be a professional person, a friend other carer or family member. Because of their close relationship with the person they are often one of the best ways to effectively communicate with them.

Let’s examine some of the services that you may wish to communicate to the older client.

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You may wish to provide information regarding some of the aids and equipment that are available, to assist them in maintaining their independence. The older person will require clear information about how the equipment works, in what situations they might use it, and the benefit it might have for them. For example: you may suggest to them to use the services of an occupational therapist visit their home to assess the need for handrails and other supports. Your explanation to them might include, that it may reduce the possible risk of falls in the home, and reduce the risk of injury and subsequent health complications which might jeopardise their future independence.

Another service that you may wish to discuss is the transformational assistance that might be available to them. Discussing the transportation options to the person and/or their advocate can highlight ways in which to maintain their independence or perhaps maintain or enhance their communication with their social network. Being able to freely move around within the community may be a way in which they can maintain contact with others who are significant their lives, and ensuring that they are still in touch with the environment beyond their residence.

As a person ages, often their financial affairs need attention. Once a person exits the workforce, there is often changes to their regular stream of income. For some people, this may not be significant or daunting due to their acquired wealth, but for others whose only source of income is the pension, significant issues to their well-being may arise.

There may be a need to discuss financial matters with them, particularly in relation that they are financially catered for as their circumstances change. In this situation, it may be appropriate to link them with the services of someone who is experienced in the management of financial affairs. It is also important that the person be assured in the knowledge that whatever financial resources they do have, are appropriately and safely managed.

All information provided relating to the provision of services should be done in consultation with your supervisor or manager to ensure that you have the necessary skills to provide the appropriate information, as well as working within the policies, procedures and guidelines of your organisation.

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ADJUST SERVICES TO MEET THE SPECIFIC NEEDS OF THE OLDER PERSON AND PROVIDE SERVICES ACCORDING TO THE OLDER

PERSON’S PREFERENCES

ACCESS AND EQUITY

What is access and equity, and how can you conduct work that demonstrates a commitment to the access and equity principles.

 Access - means to physically access different parts to a facility or service.

 Equity - means to treat every person fairly

Note: Equity does not mean to treat every person the same, this is a common misconception in the community.

Access and equity principles may include

 Provide a client-centered care

 Creation of a client orientated culture

 Non-discriminatory approach to all individuals using or accessing the service

 Respect for individual differences

WHAT IS PERSON-CENTRED PRACTICE?

Person-centred practice is treatment and care provided by health services that places the person at the centre of their own care and considers the needs of the older person's carers. It is also known as:

 Person-centred care

 Patient-centred care

 Client-centred care

Person-centred practice is treating patients as they want to be treated.

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WHY IS PERSON-CENTRED PRACTICE IMPORTANT?

It makes sense that:

 When you get to know the patient well, you can provide care that is more specific to their needs and, therefore, provide better care.

 By promoting and facilitating greater patient responsibility, patients are more likely to engage in treatment decisions, feel supported to make behavioural changes and feel empowered to self-manage.

A recent literature review found that person-centred practice can make a positive difference to health outcomes and patient satisfaction and can improve health care workers' sense of professional worth.

What are the principles of person-centred practice?

 Getting to know the patient as a person - Health care workers need to get to

know the person beyond the diagnosis and build relationships with patients and

carers.

 Sharing of power and responsibility - Respecting preferences and treating

patients as partners in setting goals, planning care and making decisions about

care, treatment or outcomes.

 Accessibility and flexibility - Meeting patients' individual needs by being

sensitive to values, preferences and expressed needs. Giving patients choices by

providing timely, complete and accurate information they can understand, so

they can make choices about their care.

 Coordination and integration - Working as a team to minimise duplication and

provide each patient with a key contact at the health service. Teamwork allows

service providers and systems working behind the scenes, to maximise patient

outcomes and provide positive experiences.

 Environments - Physical and organisational or cultural environments are

important, enabling staff to be person centred in the way they work.8

8 http://www.health.vic.gov.au/older/toolkit/02PersonCentredPractice/

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