How To Solve Some of The Biggest Issues With Client-Centred Care For People With Multiple Disabilities

Greater choices and control for people with disabilities is a key to delivering client-centred care and in the lead up to the 7th Annual National Disability Summit 2016, we had the chance to speak with Renée Heaton and DUO’s Cheryl Pollard (CEO) and Cathy Clifford (Support Worker) on the importance of the relationship between carers and consumers in service delivery and support.

Renée is, among many other things, a person living with disability since infancy. She faces the challenges and opportunities that a life with disability presents in ever creative and positive ways. Renée has a career in the Australian Public Service (APS) as a Workforce Planner. In this capacity she has, in addition to her usual duties, lead and contributed to the development of Disability Action Plans in a number of APS agencies, and implemented strategies to increase disability confidence and competence in the workplace. She also volunteers in a number of roles, currently serving as Vice-President of the Belconnen Community Service Board and a member of the DUO Customer Feedback Forum.

Renée requires some assistance to enable her to live her life, her way and these are provided informally by family and friends, and more formally through disability support agencies. The people that surround Renée are the key to her success (as well as her positive attitude and creative thinking), and she hopes to share why getting the right person to provide those supports is so important and, together with Cathy Clifford, present an example of what getting that relationship right can result in.

Cathy began working in the Community sector as a Support Worker in April 2011 with an organisation that is now called Duo.   Since that time, she has supported a wide variety of clients with respite, living skills, personnel care and social support in the Adults Program.  Cathy is also employed as an Administration Assistant with Canberra Legacy.  She is the mother of two beautiful girls, one of which has been diagnosed with mild cognitive disabilities.  Cathy began working as a Support Worker with Renée in 2011.

Renée and Cheryl, together with Cheryl, offer an honest perspectives on the reality of consumer and carer perspectives and experiences.

What range of training do support workers receive to care for people with complex and multiple disabilities? 

Cheryl:

All new support workers (regardless of previous experience) are required to undertake the Online Induction program which includes work health and safety, workplace behaviours and expectations, service delivery and practice, individual support and medication management.

Once this is completed satisfactorily, there are additional competencies they are required to undergo in the service area they indicate their preference for.

For example, if they want to do personal care, we train them in infection control, manual handling, catheter care, medaz training (epilepsy management), PEG feeding and bowel care just to name a few.
We also provide mentoring in the form of buddy-ups so both the new support worker can be supported and guided through the first few sessions.

From your experiences, how much choice, trial and error is involved in finding the right carer and negotiating outcomes? 

Renée:

In my experience to date this has very much been affected by the relationship I have with my coordinator at each agency I receive support from. And it also depends on the type of person they are and their attitude (the coordinator’s).

Coordinators have a hard job, they are basically the people that keep the business operational – agreeing or denying service provision, negotiating what will and won’t be part of the service, and then brokering the provision of that service out to a support worker. They are busy people, and somewhere in amongst all those other things, they actually have to care about getting a good outcome for the client.

From my understanding, even if the coordinator has the capability and capacity to give each individual client the attention they deserve, they are then forced to select support workers from a limited pool of people with different availability. So yes, my experience to date has not always been about getting the match right, it’s more about who is available at the right times.

Cheryl:

It can sometimes be hit and miss. The person-centred approach means we need to know as much about both parties as we can, and it’s up to the manager and coordinator (at the interview stages) to be able to tease out as much detail as possible from both sides (client and support worker).

What are some of the expectations and preferences consumers have for the skills and qualities of their carers? 

Renée:

This is going to be different for each individual. For me I expect that they arrive on my doorstep with some idea about who I am and what support I require. They should also come with an attitude of ‘I am here to assist you live your life your way’ and be open to doing things differently to how they might do it for themselves. Importantly, I expect to be treated as a mature adult and be respected for the way I choose to live my life.

The worst thing a support worker can do is speak to me like a child, which reflects an assumption they have made about my cognitive ability, or call me cutesy names such as ‘treasure’ or ‘sweetie’.

And finally, I expect the support worker to show a willingness to learn and build on our relationship. Come ready to know more about me and treat that information appropriately, but also ready to let me get to know you.

Is building a productive relationship between carers and clients as easy as matching skills and expectations? 

Renée:

I wish it was that easy. I believe that if it was we wouldn’t be needing to talk about it so much and it would make everyone’s job a lot easier. When we look at the array of relationships we have in our lives they are all different, but we do all we can to make them work. And even when they work all-right, it doesn’t necessarily mean that suddenly every problem is turned in to rainbows and puppies.

In our talk, Cathy and I will demonstrate that the relationship is made up of so much more than expectations and skills; there has to be consideration of the unique qualities that both the support worker and the client have, as personal values have a strong influence on the relationship.

It’s also about attitude, approach, communication, giving and taking, problem solving and a myriad of other things. All of these things together is just a starting point as the relationship and life experience changes along the way and the success of the relationship may depend on how changing circumstances are managed.

Cheryl:

Quite the opposite. What looks good on paper may not necessarily translate well in real life because of personalities and other dynamics. It also comes down to the reason why the support worker is doing this in the first place. We can train them and teach them professional boundaries but they also need an innate ability to rise to the occasion.

What are some the key aspects of providing client-centred care?

Cheryl:

Making sure that people are involved in and central to their care is a key component of
developing high quality care but there’s still some way to go to ensure that services are more person-centred.

Putting people at the centre of their care will improve the quality of the services they receive by getting the care they need when they need it. More importantly, it will also enable people to be more active in looking after themselves.

Person-centred care can have a big impact on the quality of care. Not only can it can improve the experience people have of care and help them feel more satisfied but it can also improve how confident and satisfied care givers can feel about the services provided.

Can you briefly describe some of key aspects in making the relationship between the support worker and client work? 

Renée :

This relationship is unique and complex which is why is so important. In our talk we’ll talk about things like making sure everyone is on the same page, having an open dialogue and making sure you communicate well right from the beginning. Doing things like talking about what’s going to happen and why and making sure there is a way to give feedback without it being a criticism.

Most importantly, remember everyone is unique so it’s going to look different for each time, so make sure to talk about that right at the beginning and come up with a way of creating an open dialogue so that you can move forward together, learn and respond to changes as they arise, and achieve a good outcome for the client while leaving the support worker feeling they’ve contributed to that outcome.

Are there any presentations from the 2016 National Disability Summit that you are looking forward to and why?

Renée:

I am most looking forward to hearing from June Reimer from the NSW Aboriginal Disability Network, because I believe it’s everyone’s responsibility to support people with disability live in their community. I’m interested in hearing about how the Network fosters that and to take away some ideas about what I can do in my community to apply that philosophy.

Cathy:

There are many presentations, such as closing gaps that exist in the diverse and complex world of Disability Service Delivery and I look forward to hearing about new solutions and existing programs such as those from the Aboriginal Disability Network New South Wales and the Brightwater Care Group.

I have heard some parents talking about how difficult it can be to find housing where they feel the best care will be provided for their adult children, so I will be interested to see presentations regarding supported accommodation.

Other clients I have worked with face ongoing challenges of finding the right resources when living with mental illness, so I’m really looking forward to hearing David Meldrum talk from the Mental Illness Fellowship of Australia. Aftercare’s presentation about Working Collaboratively also touches on topics I think will be critical in achieving successful outcomes in the new ‘world’ of NDIS.

There will be a lot to learn!

To view the upcoming National Disability Event’s agenda and list of speakers’ line up – please click here.

Continue READ >>> The Six Ps of the NDIS Scheme