FACILITATE THE EMPOWERMENT OF OLDER PEOPLE

CHCAGE001

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

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.

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.

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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CREATION OF A CLIENT ORIENTATED CULTURE AND A NON- DISCRIMINATORY APPROACH TO ALL INDIVIDUALS USING OR ACCESSING

THE SERVICE

Stigmatisation and discrimination are two major impediments to the enjoyment of human rights by older persons. Stigma is often based on myths, misconceptions and fears about older people and ageing. These myths, misconceptions and fears include beliefs that everyone loses decision-making capacity, gets dementia, becomes dependent and a burden, and ends up in residential care.

Older people are not an homogeneous group. Older women and men age differently, and the discrimination that they experience is often multi-dimensional, based not only on age but on other factors, such as gender, ethnic origin, where they live, and disability, poverty, sexuality or literacy levels.

Policy related to the delivery of aged care needs to be developed within an ageing-well framework and in a manner that respects difference and diversity. Careful consideration of health resource allocations is required to ensure that the development and implementation of an ageing-well policy promotes equality rather than perpetuating inequalities.9

The notion that there are people who are treated differently and do not receive the same satisfactory service as others is not only inappropriate but also against the law.

RESPECT FOR INDIVIDUAL DIFFERENCES

There are a number of benefits of working within the community; one of those benefits would be that you can meet a range of people from different culture, origins, and backgrounds.

It is important that no matter what the background of the individual that you show them the respect that you would want yourself to be shown:

The background could include:

 Age

9 www.humanrights.gov.au/…/human_rights_framework_for_ageing_and..

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 Gender

 Sexual orientation

 Political views

 Race

 Religion

 Disability

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

It is important that you ensure your work practices reflect the organisation’s policies and procedures. Staff can ensure that they meet organisation policies and procedures by;

 Checking that they understand them

 Clarifying with supervisors any uncertainties about any of the policies or

procedure

 Clarifying with other senior workers about any uncertainties about any of the

policies or procedure

 Requesting assistance in developing new skill and knowledge in regards to

their duties

 Actually reading the policies and procedures

 Requesting feedback on their performance

 Requesting ongoing training to improve their skills and knowledge

POLICIES AND PROCEDURES

Policies aim to tell workers and people being supported what the service values and how it goes about putting those values into practice.

They may include topics such as (but not limited to):

 Code of conduct

 Timesheet

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 Employment requirements

 Rights and duty of care

 Health care management

 Privacy and confidentiality

 Violence and safe work policy, practices, and

 Infection control and standard precautions

 Medication policy

 First aid kit work instruction

 Use of utility gloves

 Crisis situation and response

 Using the occupational health and safety

 Assessment work instruction

 Leave:

o Sick leave

o Applying for sick leave, annual leave,

o Or long service leave

o Bereavement leave

o Parental leave

o Leave without pay

 Employee information

 Disciplinary procedures

 Induction training checklist

 Recruitment checklist

 Job applicant interview

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.

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Generally, policies can help the 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.

All workers need to support the philosophy of their workplace to ensure support and care is provided according to the philosophy which guides your agency. Not understanding the policies which are built upon the philosophy, may mean they are not written clearly and can be interpreted in various ways, leading to confusion and inefficiencies. When you are involved in the process of developing and reviewing policy, you are likely to feel some ownership of the results and therefore are likely to be more supportive of the implementation and put into practice what the guidelines suggest.

How you can contribute:

 If your service has a suggestion box for identifying improvement, add your

comments

 If your service has a sub-committee to work on developing or evaluating

policy, volunteer your time

 If your service seeks nominees for a self-evaluation committee, put your hand

 By adding your contribution, you make others informed of what you do as

well as adding to your own skills and knowledge

 Find opportunities at your regular staff meetings to raise policy issues, and

ensure they are documented.10

10 www.enablelearning.biz/…/Addendum%20CHCAC318A%20October%2..

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T O P I C 3 – S U P P O R T T H E R I G H T S O F O L D E R P E O P L E

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

It is not only important but essential that you encourage and support the older person and/or their advocate/s to be aware of their rights. A right is an entitlement that every person has in the community. If you support the older person to be aware of their rights, then they are more likely to know when their rights are being breached so that they can take the relevant action to achieve their rights.

Rights may include:

 Privacy

 Confidentiality

 Dignity

 Freedom of association

 Informed choice

 To lodge a complaint

 Right to express ideas and opinions

 To an agreed standard of care

 Right not to be abused

 To use an advocate service

 To receive the care that promotes wellness

 Not to be discriminated against

The rights of the older person are detailed in a number of areas these include:

 Legislation

 Residential Care Manual

 Aged Care Act

 Industry and organisation service standards

 Industry and organisation codes of practice and ethics

 Accreditation standards

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 International and national charters

 Organisation policy and procedure

It is also important that you support the older person in understanding their responsibilities, they include:

 To respect the rights and needs of other people within the residential care

service, and to respect the needs of the residential care service community as

a whole

 To respect the rights of staff and the proprietor to work in an environment

free from harassment

 To care for his or her own health and well-being, as far as he or she is capable

 To inform his or her medical practitioner, as far as he or she is able, about his

or her relevant medical history and current state of health

 Maintain a safe environment, as far as they are practicable

COMPLAINTS

It is important that you provide information to the older person and/or their advocate/s regarding the mechanisms for lodging complaints. The federal government has a scheme which is designed for the older person to be able to lodge a complaint about the service that they are or are not receiving.

AGED CARE COMPLAINTS SCHEME

The Aged Care Complaints Scheme (the Scheme) provides a free service for anyone to raise their concerns about the quality of care or services being delivered to people receiving aged care services subsidised by the Australian Government, including:

 Residential care

 Home care packages

 HACC services

Most Australian aged care providers do their best to provide quality care and services for older Australians. However, issues can occur, so it is important to have a way for people to raise their concerns in a constructive and safe way.

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If they have a concern about the care they or someone else is receiving, it is important that they talk about it. Complaints can help providers improve the services and quality of care they provide to them or their loved one. Resolving one complaint can help other people too.11

11 http://www.health.gov.au/internet/main/publishing.nsf/content/ageing-complaints-index.htm

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

RIGHTS AND RESPOND APPROPRIATELY

If you notice, observe or suspect that the rights of an older person are not being upheld it is your duty (duty of care) to report this to an appropriate person.

INTERNATIONAL FEDERATION OF AGEING DECLARATION ON THE RIGHTS AND RESPONSIBILITIES OF OLDER PERSONS

In December 1991, the United Nations adopted a set of United Nations Principles for Older Persons, recommending that all member governments incorporate them into their programs for older people. The Principles are based on the following Declaration on the Rights and Responsibilities of Older Person.

The United Nations General Assembly summarised the Declaration as follows:

 ‘Add life to the years that have been added to life by assuring all older

persons: independence, participation, care, self-fulfilment and dignity.’

These principles form the foundation of the rights-focused approach to elder abuse that is promoted throughout this website. Go to the principles section for more specific information about these principals in action.

INDEPENDENCE

Older persons have the right:

 To access to adequate food, water, shelter, clothing, and health care through

the provision of income, family and community support and help

 To work and pursue other income generating opportunities with no barriers

based on age

 To retire and participate in determining when and at what pace withdrawal

from the labour force takes place

 To access education and training programs to enhance literacy, facilitate

employment, and permit informed planning and decision making

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 To live in environments that are safe and adaptable to personal preferences

and changing capacities

 To reside at home as long as possible

PARTICIPATION

Older persons have the right;

 To remain integrated and participate actively in society, including the process

of development and the formulation and implementation of policies which

directly affect their well-being

 To share their knowledge, skills, values and life experiences with younger

generations

 To seek and develop opportunities for service to the community and to serve

as volunteers in positions

 To form movements or associations of the elderly

CARE

Older persons have the right:

 To benefit from family support and care consistent with the well-being of the

family

 To access health care to help them maintain or regain the optimum level of

physical, mental and emotional well-being and to prevent or delay the onset

of illness

 To access social and legal services to enhance capacity for autonomy and

provide protection and care

 To utilise appropriate levels of institutional care which provide protection,

rehabilitation and social and mental stimulation in a humane and secure

environment

 To exercise human rights and fundamental freedoms when residing in any

shelter, care and treatment facility including full respect for their dignity,

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beliefs, needs and privacy and for the right to make decisions about their care

and quality of life

SELF – FULFILMENT

Older persons have the right:

 To pursue opportunities for the full development of their potential

 To access the education, cultural, spiritual and recreational resources of

society

DIGNITY

Older persons have a right;

 To be treated fairly regardless of age, gender, racial or ethnic background,

disability or other status, and to be valued independently of their economic

contributions

 To live in dignity and security and to be free of exploitation and physical or

mental abuse

 To exercise personal autonomy in health care decision making, including the

right to die with dignity by assenting to or rejecting treatment designed solely

to prolong life12

It is very important that once you recognise that an older person’s rights are not being upheld, it is your duty to report to an appropriate person. Report may be done either:

 Verbal:

 Telephone

 Face-to-face

 Non-verbal (written):

 Progress reports

12 http://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/rights_of_older_person

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 Case notes

 Incident reports

The appropriate person/s may include:

 Supervisor

 Member of senior management

 Colleagues

 Carers

 Health professionals

 External agencies (complaints and advocacy services and professional

registering authorities)

 Law enforcement officer

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

REPORT TO AN APPROPRIATE PERSON

DEFINITION

Abuse of an older person “is any act occurring within a relationship where there is an implication of trust, which results in harm to an older person. Abuse may be physical, sexual, financial, psychological, and social and/ or neglect.”

The definition helps us clearly understand the nature and types of abuse being experienced by older people. Abuse is carried out by someone close to them, with whom they have a relationship implying trust, and may include family members e.g., son, daughter, spouse, brother, grandchild, niece or friend.

Also, note that any staff member, regardless of the position held, may behave or act in an abusive manner. If you suspect a colleague or any other staff member is abusing older people, talk to your supervisor or contact the Department of Health and Ageing Complaints Investigations Scheme (1800 550 552) and seek advice.

A range of factors can contribute to elder abuse. Abuse of an older person:-

 Can happen to anyone regardless of gender, where people live, cultural or

religious background or income

 Is a breach of a person’s rights. Some of these breaches may be criminal or

civil offences

 Can be complex due to the relationships involved, the possibility of more than

one form of abuse occurring at the same time, or more than one alleged

abuser

FORMS OF ABUSE

The forms of elder abuse are similar to other forms of interpersonal violence (for example, domestic violence). Select the type you are interested in from the list below in order to get more information.

 Physical

 Sexualhttp://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/forms_of_abuse/physical http://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/forms_of_abuse/sexual

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 Financial

 Psychological / Emotional

 Social

 Neglect

PHYSICAL ABUSE

A non-accidental act which results in physical pain or injury, it includes physical coercion and physical restraint.

Abusive Physical Behaviour Includes hitting, slapping, burning, pushing, punching, pinching, biting, arm twisting, cutting, hair pulling, forced confinement to room, chair or bed.

Signs of physical abuse – these signs could indicate abuse:

– Injuries in different stages of healing – Unexplained hair loss

– Abrasions – Bruises – Welts – Burn blisters

– Rashes – Contusions

– Swelling – Tenderness

– Lacerations – Pain or restricted movements – Lack of awareness – Drowsiness

– Cringing or acting fearful – Noticeable change in physical well-being

– Weight loss – Broken or healing bones – Agitation

SEXUAL ABUSE

Non-consensual sexual contact, language or exploitative behaviour.

Abusive Sexual behaviours Includes rape, indecent assault, sexual harassment, sexual interference.

Signs of sexual abuse – These signs could indicate abuse:

 Unexplained sexually transmitted disease or infectionshttp://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/forms_of_abuse/financial http://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/forms_of_abuse/psychological_or_emotional http://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/forms_of_abuse/social http://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/forms_of_abuse/neglect

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 Bruising in genital areas or inner thighs

 Bleeding from the genital area

 Difficulty in walking or sitting not associated with a medical condition

 Fear

 Agitation

 Disturbed sleep

 Withdrawal

FINANCIAL ABUSE

The illegal, improper use and/or mismanagement of a person’s money, property or resources.

Abusive financial behaviour Includes:

Fraud

Stealing Forgery

Embezzlement

Reluctance to pay for accounts or debts

Unwillingness to bring items in for the older person

Withholding funds from the older person Resident forced to hand over management of their finances

Forced changes to a Will Enduring Power of Attorney’s refusal to provide information about financial affairs to the older person Pressure from others to hand over money or items

An unprecedented transfer of money or property to another person Unwillingness of others to repay money loaned

Signs of Financial abuse – These signs could indicate abuse:

Older person frequently changing their mind about their Enduring Power of Attorney Lack of money for items needed Loss of jewellery or personal belongings

Older person expresses fear and anxiety when discussing finances

Unexplained amounts of money missing from bank accounts Unpaid accounts

Receiving accounts for items not belonging to the person

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Loss of trust

Confusion over ownership of assets, property, etc

PSYCHOLOGICAL/ EMOTIONAL ABUSE

Psychological abuse is language or actions designed to intimidate another person and is usually characterised by a pattern of behaviour repeated over time, intended to maintain a ‘hold of fear’ over the older person.

Abusive psychological/emotional behaviour Psychological abuse may be verbal or non-verbal and can include:

– Treating the older person like a child – Humiliation

– Emotional blackmail – Blaming – Intimidation – Name calling

– Threats of restricting access to others – Insults – Threats of punishment or abandonment – Silence

– Withdrawal of affection – Shouting

– Denying the older person their rights – Coercing – Witnessing family arguments – Forced to collude in family conflict

Signs of psychological abuse – These signs could indicate abuse:

– Fearfulness – Helplessness

– Hopelessness – Withdrawal

– Reluctance to make decisions – Appearing shamed – Loss of interest in self, activities or environment – Low self-esteem

– Change in appetite – Passivity

– Depression – Confusion – Insomnia – Sleep deprivation

– Agitation – Anger

– Anxiety – Mental anguish

– Nervousness in the presence of a particular individual

SOCIAL ABUSE

Restricting or stopping social contact with others and stopping or restricting activities.

Abusive social behaviour Includes: being discouraged or stopped from seeing other people e.g., family or friends Prevented from joining in any activities in or outside the residential care facility.

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Signs of social abuse – These signs could indicate abuse:

 Loss of interaction with others

 Sadness and grief of people not visiting

 Worried or anxious after a particular visit by specific person(s)

 Appears shamed

 Low self-esteem, or is very sad

 Withdrawn

 Passive (not wanting to participate; listless, uninvolved)

NEGLECT

Neglect is the failure of a caregiver in a relationship of trust to provide necessities or blocking the provision of basic needs being provided. Neglect can be deliberate or unintended.

Abusive, neglectful behaviour Includes:

 Not providing adequate clothing, and personal items

 Unwillingness to allow adequate medical or dental care or personal care

 Over or under or inappropriate use of medication

 Refusal to permit other people to provide adequate care e.g. food or drinks

Signs of neglectful behaviour – These signs could indicate abuse:

 Poor hygiene or personal care

 Absence of health aids e.g. dentures, hearing aids, glasses and mobility

equipment

 Unkempt appearance, inappropriate, or lack of, clothing

 Weight loss

 Secretiveness or agitation

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 Lack of personal items e.g. photos, ornaments13

What type of information can you provide?

 Lodging a complaint with the Aged Care Complaints Scheme

 What can you complain about?

 Who can make a complaint?

 What types of services are covered by the Scheme?

 What happens after you lodge a complaint?

13 http://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/forms_of_abuse/physical

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

LODGING A COMPLAINT WITH THE AGED CARE COMPLAINTS SCHEME

If the person does not want to discuss their concern with the service provider or they are unable to resolve their complaint with them, they can contact the Aged Care Complaints Scheme (the Scheme).

Contacting the Aged Care Complaints Scheme: Phone 1800 550 552 (a free call from fixed lines; calls from mobiles may be charged) Online lodge a complaint using the online complaint form.

Visit the Raise a concern page on the Scheme’s website to find out their options for lodging a complaint. If they need assistance in contacting the Scheme, the free Translating and Interpreting Service can assist. If they are hearing impaired, they can contact the National Relay Service, also a free service.

WHAT CAN YOU COMPLAIN ABOUT?

They provide a free service for people to raise their concerns about the quality of care or services being delivered to people receiving aged care services that are subsidised by the Australian Government. This includes quality of care, choice of activities, personal care, catering, communication and the physical environment.

They can refer complaints we are unable to examine to other organisations. If the client lodges a complaint with them, and they can’t help you, they will tell you why and who you can contact.

WHO CAN MAKE A COMPLAINT?

Anyone can make a complaint, including:

 Care recipients

 Their representatives

 Family members

 Friends

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 Legal representatives

 Aged care staff

 Volunteers

 Health professionals

WHAT TYPES OF SERVICES ARE COVERED BY THE SCHEME?

They can examine complaints about the following Australian Government-subsidised aged care services:

 Residential care

 Commonwealth funded HACC

 Home care packages

If clients are unsure about whether a service is included in the list above, they can ask the service provider or contact the Scheme. Their contact details can be found on the Raise a concern page on their website.

WHAT HAPPENS AFTER YOU LODGE A COMPLAINT?

When the client lodges a complaint with them, they will explain the process, options and what can be achieved through those options. The client may be asked to clarify their issues, provide more information and discuss their expectations.

It is important that they provide as much information as they can when they lodge their complaint. This helps them to understand all the issues and determine the most appropriate way to resolve the client’s concern.

The Complaints Principles 2011 made under the Aged Care Act 1997 contain detailed procedures regarding the operation of the scheme14

14 http://www.health.gov.au/internet/main/publishing.nsf/content/ageing-complaints-index.htm

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T O P I C 4 – P R O M O T E H E A L T H A N D R E – A B L E M E N T O F O L D E R P E O P L E

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

There are going to be times that you are going to have to assist the older person to recognise the impact that physical changes associated with ageing may have on their activities of living.

It is important to remember, when interacting with people do not focus too much on their age. Just because a person may be 80 or 90 years old does not mean he or she is frail or dependent on others for the basic necessities associated with everyday living. Instead of “How old?” it is better to consider “How functional?” Age-related changes may or may not impact one’s ability to perform daily living activities. Visible changes such as age-spots, gray hair and wrinkles have NO impact on daily living activities.

Natural changes affecting vision, hearing, muscle and bone mass and memory may present functional challenges. Notable concerns often include the inability to read small print and actively participate in conversations. Additionally older people face an increased risk of falling and injury.

Age-related conditions, such as arthritis, dementia, heart disease and/or stroke can make it difficult for people to perform daily living activities (e.g., cooking, cleaning, driving, walking) and may present safety risks.

To address these challenges, some people opt to use assistive devices, (e.g., cane, walker, hearing aid, glasses) while others enlist the help of family and professional caregivers to make life easier. Other challenges may simply become a part of life that people need to adjust to.

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When you are assisting the person, it is important that you engage with them to discuss their needs (NOT what you think they need). There are many different dimensions of support these are often called wellness dimensions, these include;

 Physical Wellness — a lack of illness and/or disability

 Emotional Wellness — an ability to cope and manage stress

 Intellectual Wellness — the ability to think, reason and remember

 Social Wellness — the ability to connect with a support system of family and

friends

 Occupational Wellness — the ability to work and/or volunteer

 Spiritual Wellness — a sense of purpose and meaning beyond one’s self

 Environmental Wellness — feeling safe at home and around the community

 Financial Wellness — having sufficient money to meet basic needs

It is important that workers support the clients:

 Self-esteem

 Self-confidence

 Sense of purpose

 And their wellbeing.

Consider the following as you interact with older people:

 Just because people are older does not mean they are unable to function

independently. Functional ability is different for everyone. Encourage people

to do the things they CAN do, and give support to them for the things they

cannot do for themselves.

 If you are concerned an older person has a functional limitation that may put

him and her at risk, consult your management and/or local agency on ageing

15 nursing.uc.edu/…/Module%202_GDST_Referen…

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AGE-RELATED CHANGES

When working in the community and dealing with older people it is very important that you take into account the physical changes that are associated with ageing.

Some age-related changes, such as wrinkles and grey hair, are inevitable. It was once thought that changes to muscles, bones and joints were unavoidable too. However, researchers now suggest that many factors associated with ageing are due to inactivity and that performing physical activity can help to reduce or reverse the risk of disability and chronic disease

MUSCLE AND BONE CONDITIONS IN OLDER AGE

Nearly half of all Australians over the age of 75 years have some kind of disability. Common conditions affecting muscles and the skeleton, or the musculoskeletal system, in older people include:

 Osteoarthritis – the cartilage within the joint breaks down, causing pain and

stiffness.

 Osteomalacia – the bones become soft, due to problems with the metabolism

of vitamin d.

 Osteoporosis – the bones lose mass and become brittle. Fractures are more

likely.

 Rheumatoid arthritis – inflammation of the joints.

 Muscle weakness and pain – any of the above conditions can affect the

proper functioning of the associated muscles.

AGE-RELATED CHANGES IN MUSCLE

Muscle loss size and strength as we get older, which can contribute to fatigue, weakness and reduced tolerance to exercise. This is caused by a number of factors working in combination, including:

 Muscle fibres reduce in number and shrink in size

 Muscle tissue is replaced more slowly and lost muscle tissue is replaced with

a tough, fibrous tissue

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 Changes in the nervous system cause muscles to have reduced tone and

ability to contract

AGE-RELATED CHANGES IN BONE

Bone is living tissue. As we age, the structure of bone changes and this results in loss of bone tissue. Low bone mass means bones are weaker and places people at risk of breaks from a sudden bump or fall.

Bones become less dense as we age for a number of reasons, including:

 An inactive lifestyle causes bone wastage

 Hormonal changes – in women, menopause triggers the loss of minerals in

bone tissue. In men, the gradual decline in sex hormones leads to the later

development of osteoporosis

 Bones lose calcium and other minerals

AGE-RELATED CHANGES IN JOINTS

In a joint, bones do not directly contact each other. They are cushioned by cartilage that lines your joints (articular cartilage), synovial membranes around the joint and a lubricating fluid inside your joints (synovial fluid). As you age, joint movement becomes stiffer and less flexible because the amount of lubricating fluid inside your joints decreases, and the cartilage becomes thinner. Ligaments also tend to shorten and lose some flexibility, making joints feel stiff.

Many of these age-related changes to joints are caused by lack of exercise. Movement of the joint, and the associated ‘stress’ of movement helps keep the fluid moving. Being inactive causes the cartilage to shrink and stiffen, reducing joint mobility.

PHYSICAL ACTIVITY CAN HELP

Exercise can prevent many age-related changes to muscles, bones and joints – and reverse these changes as well. It’s never too late to start living an active lifestyle and enjoying the benefits.

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Research shows that:

 Exercise can make bones stronger and help slow the rate of bone loss

 Older people can increase muscle mass and strength, through muscle-

strengthening activities

 Balance and coordination exercises, such as Tai chi, can help reduce the risk

of falls

 Physical activity in later life may delay the progression of osteoporosis as it

slows down the rate at which bone mineral density is reduced

 Weight-bearing exercise, such as walking or weight training, is the best type

of exercise for maintenance of bone mass. There is a suggestion that twisting

or rotational movements, where the muscle attachments pull on the bone, are

also beneficial

 Older people who exercise in water (which is not weight bearing) may still

experience increases in bone and muscle mass compared to sedentary older

people

 Stretching is another excellent way to help maintain joint flexibility

See your doctor before you start any new physical activity program. If you haven’t exercised for a long time, are elderly or have chronic diseases (such as arthritis), your doctor, physiotherapist or exercise physiologist can help tailor an appropriate and safe exercise program for you. If you suffer from osteoporosis, you may also be advised to take more calcium. Sometimes, medications are needed to treat osteoporosis.16

TYPICAL PHYSICAL CHANGES

Some of the typical physical changes that can occur as a person ages are:

 Wrinkles

 Graying or loss of hair

 Thickening of the body

 Decline in senses

16 http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Ageing_muscles_bones_and_joints

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 Decline in reaction time

 Arthritis (pain, limited movement)

 Decline in the elasticity of the muscles and skin (body)

Also, there are changes to the body systems themselves. For example:

Integumentary system; As the skin ages, it flattens due to the loss of sub-cutaneous fat, skin cells, sebaceous (oil) glands, sweat glands, melanocytes (pigment cells), and hair follicles. Lentigo (senile freckles) occurs, blood flow to the skin is decreased, and nerve endings are lost or become less sensitive. As a result, the skin loses some of its effectiveness: as a protector against bacteria, as an insulator, as a thermal regulator, and as a sensory receptor. Since these losses cause wrinkling, loss of elasticity, freedom of movement and expression are inhibited. The slowing of circulation results in slower healing. The loss of color is also seen, as the hair becomes gray. The skin generally functions well throughout life, though, and most changes in the skin due to aging are not life-threatening. Most of the deleterious changes in the skin are cosmetic, as the drying and thinning result in sagging and wrinkling, the hair becomes sparser and gray or white, and the fingernails become rigid, tend to yellow, and are prone to splitting. Skin disorders more common in the aging skin are senile pruritis (itching), keratoses (thickening in patches), skin cancer, and decubitus ulcers (pressure sores), and herpes zoster (shingles).17 The Skeletal System: The primary factor in the aging of the skeletal system is the loss of bone matter. This loss is called osteoporosis and refers to bone loss. The basic cause of bone loss is the fact that the relative rates of production of osteoblasts (bone forming cells) and osteoclasts (bone dissolving cells) changes so that more bone matter is dissolved than is laid down. This loss is much greater in women than in men. Other factors in the aging skeletal system are loosened cartilage around the joints, depleted lubricating fluid in the joints, and hardened and contracted ligaments. These factors occur more in men than in women. The effects of these changes on our health status are significant. Bones become brittle and less supportive of our activities, resulting in less activity, which in turn results in poorer health. The excess bone taken up tends to reside in the arteries and local blood vessels, causing decreased circulation. As broken bones occur, less mobilization results in other health hazards.

17 http://www.longestlife.com/ebook/change.htmlhttp://www.longestlife.com/ebook/change.html

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The social implications of these effects are widespread, especially in advanced conditions. One becomes more dependent upon others, who might begin to avoid. One is less able to visit and to participate in social events. The alternatives to immobilization are difficult. Family, friends, and the community must be open to assisting these individuals, and must be alert to avoid ascribing more limitations than are actual. Other alternatives are preventive techniques. The following diseases tend to increase the incidence of osteoporosis, and so should be treated diligently: chronic alcoholism, diabetes, hyperthyroidism, uraemia, and collagen disease (rheumatoid arthritis).18

The Muscular System:

Since muscle cells are post-mitotic cells (unable to replace themselves once they are formed), all muscle cell loss is permanent. Even though muscular response gradually slows with age even under the best conditions, the loss of muscular capabilities is by far mostly the result of cell loss due to inactivity. As muscle cells are lost, weakness and slowness increase.

The effects of these changes on our health status are not, in themselves, greatly deleterious. The muscles, however, are the main tools for effecting strong circulation throughout the body. The social implications of these changes are related both to appearance and to movement. As the muscles become smaller, including the muscles in the face, and as adipose (fat) tissue accumulates, including in the face, the entire appearance changes to that of an older person, with all the ramifications described above in the description of skin changes. In addition, as muscle fibres decrease, weaken, and slow, it becomes increasingly difficult to keep up with younger people, who may make allowances, but who may also become avoidant.19

For further information on the bodies response to aging please go to:

http://www.longestlife.com/ebook/change.html

18 http://www.longestlife.com/ebook/change.html 19 http://www.longestlife.com/ebook/change.htmlhttp://www.longestlife.com/ebook/change.html http://www.longestlife.com/ebook/change.html http://www.longestlife.com/ebook/change.html

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Other areas that may be affected by ageing are the senses, these include:

 Touch

 Smell

 Taste

 Sight

 Hearing

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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

It is important that you recognise and accommodate the older person’s interests and life activities when delivering services. This is the basic right of the person to be able to live in the way that they were prior to your delivery of service. This is what is known as person-centered care.

Some of the routines that the person may conduct on a daily basis may include, but not limited to:

 Get up

 Going to bed

 Eating meals

 Going to toilet

 Showering

 Feeding the animals

PROMOTING INDEPENDENCE AND AUTONOMY

Older people typically wish to retain and improve their independence and autonomy. This means keeping or improving physical and cognitive function to fulfil the tasks of independent living, maintaining social connections, and making decisions about their care.

Traditionally, support services have been delivered in a task-oriented way that comes from a ‘do to or for’ approach rather than ‘support to do’ or ‘do with’ approach.

Service delivery has often focused on a person’s weaknesses and what they are unable to do, rather than using a strengths-based approach focused on capacity building and restorative care.

The HACC Active Service Model is a quality improvement initiative which explicitly focuses on promoting capacity building and restorative care in service delivery. It is

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important to note that capacity building in this context does not only relate to physical function but includes social and psychological wellbeing.

The core components of an active service approach that can also be applied within a residential care setting include:

 Capacity building, restorative care and social inclusion

 A holistic person-centred approach to care that promotes wellness and active

participation in goal setting and decisions about care

 Timely and flexible services that respond to the person’s goals and maximise

their independence

 Collaborative relationships between service providers

Emerging research suggests that service delivery models with health promoting, capacity building approach can have positive and long reaching benefits. This means focusing service delivery on optimising an individual’s functional and psychosocial independence.

Strategies for supporting independence and autonomy include to:

 Do with and provide support to do, rather than doing to or for

 Acknowledge the role, both past and present, of the older person

 Find out about what the person values in their lifestyle and what they would

like to change if they could ‘turn back the clock’ or ‘get back on their feet’

(metaphorically speaking)

 Identify client abilities using strengths-based assessment practice

 Acknowledge that the complexity of a person’s needs will impact on their

level of autonomy

 Provide opportunities for the person to practice and enjoy their skills

 Encourage people to learn new skills, including problem-solving skills

 Ask the person what they think the best way to solve a problem may be to

support their emotional well-being

 Provide opportunities for valued roles, such as volunteering or organising,

and thank the person for their contribution

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 Encourage self-management of health by involving the person in care

decisions and activities of daily living

 Develop a goal orientated support plan with the person that reflects their

goals, desires and preferences

 Design and implement service delivery options that support independence,

autonomy and a sense of wellbeing for the person

 Provide a user-friendly environment, for example, easy to open windows and

doors and ramps instead of steps

Examples for use in everyday practice:

 Access equipment to enable the person to do their own personal care.

 Introduce aids and appliances, such as hearing aids and walking frames.

 Ask about the fear of falling (which can limit independence) and how to

reduce it

 Consider devices that facilitate calling for help, such as a telephone alarm

button or personal alarm, which may restore self-confidence

 Provide programs to help people connect with other members of their local

community and community of interest (for example, CALD communities,

GLBTI communities, Count us in!)

 Use environmental modifications

 Involve participants in planning and leading activities

 Share roles (depending on capacity) usually carried out by staff, such as

making cups of tea, setting up craft materials, cooking and serving meals,

welcoming new people, taking photos, writing newsletters, or sending cards

to group members who are unwell20

PURPOSEFUL ACTIVITIES

The way older people think about the quality of life and mental or emotional health is not much different from the way younger people think. Most people need to feel like a useful member of society and connected to their community. Being able to contribute to

20 www.health.vic.gov.au/…/wellforlife/ewb_resi_complete.pdf

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family and community—whatever this means for an individual—can be important to emotional well-being.

Acknowledging roles, skills and interests find out about the interests, roles and responsibilities the person had when they were younger, or they still have. These can include both formal paid roles as well as informal or voluntary roles.

These roles may have been in Australia or in other countries. For example:

 Aboriginal Elder Entertainer Parent/grandparent

 Accountant Farmer Passing on cultural traditions

 Aunt/uncle Home maintenance Public servant

 Builder Home management Shopkeeper

 Chef Local business person Sports coach

 Council member Musician Writer, journalist

 Driver Nurse or teacher Volunteer

Listen to the person and consider what they most often reflect about. You may hear statements such as:

 ‘When I used to do [?]’

 ‘I do miss the excitement and responsibility of [?]’

 ‘We used to have so much fun when we [?]’

 ‘Times have changed, and we don’t seem to do [?] as much anymore

 ‘At home in [name of country] we used to [?].’

Comments such as these can prompt a conversation where you can find out more and think about activities that that could provide the person with a sense of connection to their current or previous roles and responsibilities. With older people from CALD backgrounds, you may need to ensure access to interpreters to facilitate the conversation.

With older gay, lesbian, bisexual, transgender or intersex (GLBTI) people you may need to create a safe, non-judgemental and affirming environment for disclosure of sexual and preferred gender identity, recognising that not everyone doing so will be comfortable being ‘out’. Activities linked to previous roles can provide a sense of being

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productive and contributing to society and community and, therefore, enhance emotional wellbeing.

Introducing new interests can also provide a sense of achievement, productivity and contribution.

Think about new activities that build on the person’s strengths and interests. When running activities in residential aged care facilities, consideration should be given to residents’ capabilities, length of activity, time of day, seating arrangements and so forth.

WHAT NEW INTERESTS COULD BE INTRODUCED?

 Gardening, picking produce and raising seedlings

 Link into Count us in! project initiatives

 Discussing food choices and finding recipes

 Keeping chickens for eggs for use in facilities or for selling at local markets

 Being involved in local groups, committees, book clubs, University of the 3rd

Age courses, Men’s Shed, football, bowls, social service, music festivals, dining

out, libraries or Tai Chi

 Internet café and pen pal program

 On-line learning and computer skills

 Family tree research

 Maintenance opportunities, painting, being around builders

 Folding laundry and clothes

 Participating in shopping, going to the local shop for newspapers or

magazines, coffee and morning/afternoon teas

 Intergenerational activities—connections with local schools and child care

centres to develop learning opportunities for children and older people (for

example computers, reading, local history)

 Reconnect with communities of interest (for example GLBTI celebrations and

media)

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 Use virtual visiting technology or SKYPE to stay in touch with family and

friends regardless of their geographic location21

BENEFITS OF HEALTHY ACTIVITIES

Leading a healthy active life is beneficial in so many ways. It can provide a huge range of fun experiences, make them feel good, improve their health, and is a great way to relax and enjoy the company of friends.

Regular physical activity can:

 Help prevent heart disease, stroke and high blood pressure

 Reduce the risk of developing type ii diabetes and some cancers

 Help build and maintain healthy bones, muscles and joints reducing the risk

of injury

 Promote psychological well-being

21 www.health.vic.gov.au/…/wellforlife/ewb_resi_complete.pdf

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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

Activities of daily life refer to tasks of daily life such as eating, drinking, dressing, bathing, hygiene, meal preparation, housekeeping and other personal and/or domestic tasks.22

Providing the appropriate assistance and equipment can play a significant role in supporting the independence of the older person. There are a wide range of items available. Some are relatively inexpensive and can be independently purchased from stores or online. Other items of equipment are complex and expensive and require individualised and specialised fitting and instruction. There is a lot of interest and development in new technologies to assist in providing care and support to an ageing population. To be effective in improving capacity for independent living, equipment and advice about correct use needs to suit each individual and their circumstances. Given the range of items available, there is also a range of solutions to getting the correct advice.

Community service workers can facilitate the use of living equipment in a range of ways. For example, by:

 Assesmbling equipment as required

 Observing and discussing tasks that a person may find difficult

 Identifying tasks for which easy living equipment may be helpful

 Providing information and demonstrating the correct use of easy living

equipment

 Assisting with purchase or supply

 Prompting, encouraging, motivating and monitoring the use of easy living

equipment

For the older person, everyday tasks, such as opening a jar or tin of food, drying feet, putting on socks or stockings, or performing cleaning tasks may become increasingly challenging. The reduced ability to undertake domestic and household tasks, maintain personal care, or prepare food is often a catalyst for a referral to Home and Community

22 http://www.mav.asn.au/policy-services/social-community/ageing/home-community- care/Related%20documents%20%20HACC%20Easy%20Living/HACC%20Easy%20Living%20Equipme nt%20guide.docx.

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Care (HACC) services. Promoting the use of easy living equipment is about assisting people to overcome challenges and maintain their independence to the greatest extent possible. In some cases, it may also reduce the need for services.

Equipment that may be suggested by the support worker in relation to assisting the older person with their activities of daily living may be in relation to issues such as:

 Domestic and household cleaning

 Bathroom and personal care

 Kitchen and meal preparation

 Recreational and household items

One of the roles of the support worker is to assist in making it easier for the older person to achieve and maintain their independence as much as possible. When doing so they must ensure that they are doing so within the scope off their work. Apart of the service they provide, they may wish to suggest specialist referrals to the client so to the appropriate support can be provided.

In assisting the older person who is living at home, they might suggest the intervention of home and community care to ascertain their needs in their home. Referral to specialist services such as this ensures that the worker is keeping in line with their role and responsibilities.

Please see below an example of the referral process undertaken by Home and Community Care.

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Assessment discussions with the older person should include a detailed discussion with the client and their significant others where appropriate, about their experiences in performing their daily tasks, and discussing a range of strategies and options to assist them in areas where they might be experiencing difficulties. These discussions should lead to the identification of ways to increase their independence.

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DISCUSS SITUATIONS OF RISK OR POTENTIAL RISK ASSOCIATED WITH AGEING

Regardless of the environment in which they live, the older person needs to feel that they are secure and safe in their living situation. They should feel secure in the knowledge that they are able to move around in their surroundings without feeling that they are vulnerable to harm. Older people, particularly those who live at home alone, may sometimes feel that they are easy targets for criminal activity such as violence and robbery.

When working with older people it is important to try and establish a sense of security and confidence so that they may maintain their sense of confidence and empowerment. The client needs to feel that they have a sense of control over their security and that they have the ability to use strategies to protect their well-being. Whist, the older person, may not able to defend themselves well from physical violence, there are other measures they can take to improve their security.

Security does not just mean being able to ward off offenders. It incorporates other issues such as ensuring their own personal safety when they are moving around in their environment, having shelter and protection, feeling comfortable in their environment and knowing that they are free to express themselves as they desire.

Some of the requirements of the older person in relation the establishment and maintenance of their security are:

 Security systems and how they work

 Support staff that recognise the need for the older person to feel secure in

their environment

 To have the information relative to security issues close at hand, easy access

to security and emergency contacts

 That the environment is suitably adapted to ensure the security and safety of

the older person

The support worker is able to link the client with the appropriate mechanisms so that they will be able to maintain their safety and security in the following ways:

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SECURITY SYSTEMS

There are numerous ways that the support worker in conjunction with the client can promote and ensure that security is established and improved. Examples are:

 Installing alarm and emergency systems

 Security patrols

 Regular visits from support workers to ‘check -up’ n the client

 Ensuring that entrance doors have adequate locking mechanisms including

dead bolt locks.

 Having emergency numbers close by to every telephone in the house and

where appropriate stored in mobile phones

 Ensuring that safety mechanisms such as thermostats, smoke alarms and

electrical protection devices are in place and are regularly serviced and

maintained

 Having adequate and emergency lighting available at all times

 Ensuring that all mobility assistance devices e.g. handrails are securely fitted,

fastened and appropriately placed according to the needs of the client

SHELTER AND PROTECTION

Older people need to know that they are able to live in an environment that provides them with shelter, where they are sheltered from the outside environment when they need to be and that they are protected from the elements. Likewise, they should feel that they are assured in the knowledge that there are others to protect them should they require assistance. This might include having access emergency services if necessary, and the support of friends, family, and support services to assist them in times of need.

COMFORT AND SELF EXPRESSION

Not only should the environment of the older person reflect their physical comfort, but the person should also feel emotionally comfortable in their environment. The support worker can help the older person to be surrounded by the things that they enjoy in life. For example; an important aspect of the older person’s life might be the ability to have regular interaction with others. The support worker can assist by helping to organise a carer to visit the client on a regular basis so that they have someone with whom they a have regular, meaningful conversations.

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SAFETY AND ADAPTATIONS

The older person’s safety is of paramount concern in relation to their well-being. The client should feel that they are not at risk from harming themselves as a result of the very environment in which they live. Accidents in the home can be a prime source of injuries, possibly even result in death if the appropriate measures are not taken to eliminate or minimise potential hazards.

As a person ages, their bones become more brittle, their sense of sight, smell and touch tend to deteriorate, as does their sense of judgment and reaction time. For these reasons, they are more prone to injuring themselves in any environment. The following is a list of measures and modifications that can be implemented to minimise the risk of harm in their living environment:

 Inside and outside door handles and locks are easy to operate

 Door handles are lever-action instead of round knobs

 Carpeting and rugs are not a trip hazard

 Appliances, lamps and cords are clean and in good condition.

 Electrical overload protection is provided by circuit breakers, fuses

 Electrical cords are placed out of the traffic flow and are not underneath rugs

and furniture

 Ensuring the kitchen area is well lit

 Making sure that there is adequate ventilation, particularly near heating and

cooking areas

 Cabinets and shelving should be easily accessible to the client

 Non-slip flooring is in place

 Temperature limiters for the hot water system

 Smoke detectors are fitted and working

 Telephones are easily accessible in the event of an emergency

 Light switches should be easily accessible

 Emergency lighting such as torches are available

 Handrails and handles are appropriately placed and securely fastened

 Garden areas and aces paths are kept clear of obstructions

People working with older clients need to be aware of their role in ensuring that the security of the older person is maintained wherever possible. This will, of course, be

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dependent upon the person being willing and able to implement the suggested changes and adaptations to their environment.

RECOGNISING HAZARDS

When working in any organisation, it is imperative that the staff comply with Work Health and Safety legislation and adhere to organisational policies and procedures at all times.

As part of your role when working in the community services sector, you are responsible for the identification and prevention of potential hazards which might adversely affect the health and well-being of your clients, co-workers and yourself.

When working in your organisation, you should:

 Be aware of the procedure for reporting hazards

 Know who to report hazards to so that they will be actioned appropriately

 Know your role if the hazard is not addressed

 Know the legislative requirements and your role where these are concerned

 Know your role in addressing hazards when you find them; can you resolve

the hazard or does it need to be someone else

ASSESSING HAZARDS

There are a number of factors that play a part in the probability and degree of injury or illness for a particular hazard. For example, contact with blood & body fluids exposure.

The significance of the risk of injury or illness may be influenced by the level of a worker’s exposure to a hazard. For example, the hazard posed by exposure to a solvent increases with the frequency and duration of exposure.

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SEVERITY

Severity refers to the extent of the injury or degree of harm which might be caused by a hazard. Death, permanent disability or an illness such as cancer or hepatitis are all classed as severe. Some examples are electrical hazards and machinery; chemicals such as acids, and dust particles such as asbestos.

ANALYSING THE LIKELIHOOD AND CONSEQUENCES OF RISK

Let’s now look at the likelihood of the risk happening. We need to assess how likely it is that the risk will happen and what the consequences of this could be.

Consequence is measuring the consequences of being exposed to a hazard. As a risk assessor you are asking whether the hazard is so:

 Severe = E.g. Death, extreme injury or permanent disability

 Major = E.g. Long-term injury or illness

 Medium = E.g. Medical attention required with time off work

 Minor = E.g. First aid required/hazard or near miss report completed with

follow-up action

 Insignificant = E.g. No Injury or near miss follow-up action required

Likelihood is assessing how likely it is that a hazard will harm someone. This likelihood will range from:

 Rare

 Unlikely

 Possible

 Likely

 Almost certain

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HAZARD RATING MATRIX CHART

If you line up the likelihood and consequences on this chart, you will see that it will guide you to the type of risk i.e. low, medium, high or extreme.

REPORTING RISKS AND HAZARDS

Ensuring you report all hazards and risks is an important part of anyone’s role when working with children. All incidents and hazards must be reported using your centres Pro-forma for reporting.

You must completed a hazard report and issue this report to the authorised person. This will usually be your supervisor or manager but in the case where you are the centre manager you may have to report to a higher authority, either way the report must be submitted and the process of eliminating or controlling the hazard commenced.

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PALLIATIVE CARE

Curative care refers to treatment and therapies provided to a patient with an intent to improve symptoms and cure the patient’s medical problem. Antibiotics, chemotherapy, a cast for a broken limb — these are examples of curative care. An example of this could be, Justine was given oral antibiotics to cure her bacterial infection.23

The term “curative care” is often used in contrast with “palliative care,” which is a treatment or therapy that does not aim to cure the patient. Palliative care is care provided for people of all ages who have a life-limiting illness, with little or no prospect of a cure, and for whom the primary treatment goal is the quality of life.

The World Health Organisation describes palliative care as:

“…an approach that improves quality of life of patients and their families facing the problem associated with life-threatening illness, through the prevention of suffering by of early identification and impeccable assessment and treatment of pain and other problems, physical, psychological and spiritual.24

Palliative care:

 Provides relief from pain and other distressing symptoms

 Affirms life and regards dying as a normal process

 Intends neither to hasten or postpone death

 Integrates psychological and spiritual aspects of patient care

 Offers a support system to help patients live as actively as possible until death

 Offers a support system to help the family cope during the patient’s illness

and in bereavement

 Uses a team approach to address the needs of patients and their families,

including bereavement counselling if indicated

 Will enhance quality of life, and may also positively influence the course of

illness

 Is applicable early in the course of illness, in conjunction with other therapies

that are intended to prolong life, such as chemotherapy or radiation therapy,

23 http://patients.about.com/od/glossary/g/curative.htm 24 http://primarycare.palliativecare.org.au/portals/29/gp/PRIMARY%20CARE_PALLIATIVE…http://primarycare.palliativecare.org.au/portals/29/gp/PRIMARY%20CARE_PALLIATIVE%20CARE%20RESOURCE%20KIT%20CD%20PRESENTATION_0506.pdf

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and includes those investigations needed to better understand and manage

distressing clinical complications”25

S U M M A R Y

Now that you have completed this unit, you should have 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.

If you have any questions about this resource, please ask your trainer. They will be only too happy to assist you when required.

25 www.who.int/cancer/palliative/definition/en.

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R E F E R E N C E S

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

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

http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Ageing_muscles_bon es_and_joints

http://www.health.gov.au/internet/main/publishing.nsf/content/ageing-complaints- index.htm

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

http://www.islhd.health.nsw.gov.au/Carer_Program/Documents/State_documents/Res ea…

http://www.longestlife.com/ebook/change.html

http://www.mav.asn.au/policy-services/social-community/ageing/home-community- care/Related%20documents%20%20HACC%20Easy%20Living/HACC%20Easy%20Liv ing%20Equipment%20guide.docx.

http://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/rights_of_ol der_person

nursing.uc.edu/…/Module%202_GDST_Referen…

www.enablelearning.biz/…/Addendum%20CHCAC318A%20October%2..

www.health.vic.gov.au/…/wellforlife/ewb_resi_complete.pdf

www.humanrights.gov.au/…/human_rights_framework_for_ageing_and..http://sielearning.tafensw.edu.au/MCS/CHCAOD402A/chcaod402a_csw/lo/8511/8511_00.htm#ID0E4F http://sielearning.tafensw.edu.au/MCS/CHCAOD402A/chcaod402a_csw/lo/8511/8511_00.htm#ID0E4F http://www.adhc.nsw.gov.au/individuals/support/directing_my_own_life http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Ageing_muscles_bones_and_joints http://www.betterhealth.vic.gov.au/bhcv2/bhcarticles.nsf/pages/Ageing_muscles_bones_and_joints http://www.health.gov.au/internet/main/publishing.nsf/content/ageing-complaints-index.htm http://www.health.gov.au/internet/main/publishing.nsf/content/ageing-complaints-index.htm http://www.health.vic.gov.au/older/toolkit/02PersonCentredPractice/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 http://www.longestlife.com/ebook/change.html http://www.mav.asn.au/policy-services/social-community/ageing/home-community-care/Related%20documents%20%20HACC%20Easy%20Living/HACC%20Easy%20Living%20Equipment%20guide.docx http://www.mav.asn.au/policy-services/social-community/ageing/home-community-care/Related%20documents%20%20HACC%20Easy%20Living/HACC%20Easy%20Living%20Equipment%20guide.docx http://www.mav.asn.au/policy-services/social-community/ageing/home-community-care/Related%20documents%20%20HACC%20Easy%20Living/HACC%20Easy%20Living%20Equipment%20guide.docx http://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/rights_of_older_person http://www.sa.agedrights.asn.au/residential_care/preventing_elder_abuse/rights_of_older_person http://www.enablelearning.biz/…/Addendum%20CHCAC318A%20October%252 http://www.humanrights.gov.au/…/human_rights_framework_for_ageing_and

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