Support older people to maintain their independence August 2009 CHCCAC317A Support older people to maintain their independence August 2009

This Unit involves: Supporting older people with their daily activities Checking an older person’s ability to do daily activities Making sure an older person’s environment is suitable, safe and secure. Supporting a person experiencing loss & grief

Older People Everyone's needs are different, they can be complex and include physical, emotional, educational, safety, social, cultural, religious and sexual. In meeting the individual needs of each client in our care, it is important to acknowledge that all these needs have to be met -if one of these needs is not met it can impact on other needs. Meeting these needs is a team approach, we are part of a multidisciplinary team and we need to be aware of the roles and responsibilities of all team members.

Care plans Outline the needs of the client, it is a written document that clearly explains the following about the client: Health status Problems/ issues Goals and outcomes Interventions Responsibly of team members It is essential to abide by the organisations p & p.

Maintaining independence One of our aims in aged care is to promote the maintenance of independence. So that clients can engage as independently as possible within the community . Our role may be to assist with ADLs such as assisting in the home- meals & cleaning; garden- yard maintenance; community- involvement in activities such as hobbies, sport, education... Activities assist clients to meet social, emotional & recreational needs, without which may lead to isolation/increased dependence/depression....

Supporting ADLs Independence is linked to control, choices and confidence. As people get older they may need to rely on others to undertake ADLs Ageing in place may mean older people need support with ADLs & information. When an older person can no longer independently complete daily tasks (ADLs) we need to establish cause as well as offer the support needed.

Doris can no longer see clearly, her eye sight has deteriorated to the point she cannot see the cooking knobs on the stove & cannot read cooking recipes and instructions. It is not safe for her to cook. Therefore she may need support with cooking & reading, provision of magnifying page so she can read the recipes, provision of equipment to make cooking easier for her. There are a number of ways a person can get support- family/ friends/ community or local council support. The amount & type of support is different depending upon wether a client lives at home, community or residential care.

Support Home and garden maintenance can be supported with family/ friends, govt. Funded organisations, private businesses such VP lawn mowing/housekeeping; staff at aged care facility or retirement village. Older people ideally will live their lives as they wish, catch up with friends, keep appointments, shopping dates, playing sport etc.... Support with transport may be needed, this could be in the form courtesy buses, shopping transport via local council, private services such as taxi, volunteer services, subsidised transport passes via the govt.

Some older people need someone to go out with them due to poor memory, vision/ hearing, gait and mobility problems.... They may need assistance to push a shopping trolley or to get around from one place to the next and keep appointments. This may be part of a carer or volunteers role within the community. Helping with household tasks may be putting the laundry on the line, preparing meals- a client is encouraged to do as much as possible and the assistance provided is only for the gaps. Assistance may be provided via HACC program or privately such as meals on wheels.

Personal or financial matters Older persons may need assistance with reading or writing due to memory or vision impairment for example. Assistance may be provided from family/ friends; HACC services for reading/writing, guardian or power of attorney may be appointed to assist with financial decisions.

Caring for pets As an older persons condition changes they may no longer be able to walk, wash, brush or take their pet to the vet. Support services may be via friends/ family, volunteers, HACCs, private services such as mobile vet.

Helping older people to find support First the level of help needs to be established by asking the client and significant others what help is needed, observe the client to identify areas needed support, the client can be assessed via ACAS . Once the level of support needed is established the client can then be matched to services. As an aged care worker you need to know the level of services you and your organisation can provide. A communication book and care plan needs to be established. Not all older people are happy to get support for reasons such as loss of independence...

Support provision You must practice within your scope of practice and according to your p & p of your employer for example you may be employed to assist a client with household duties but not allowed to climb a ladder to change a light bulb or clean away cob webs.... The provision of support is individual to the client and dependent upon their care plan and level of need. The care plan will describe the level of support and where the support will be provided. The older person needs to know where, when, by whom the support will be provided and what the service will not do.

Care Plans Explain the care requirements of the client The client should where possible be involved in the development of a care plan. Within the community the plan should include the support provided by family/ friends/ volunteers and other services; such a plan may also be referred to as service plans, support plans or service delivery plans. Plans need to be updated regularly and changed as the clients needs change. It is important to read your clients care plans and understand the information in them – always ask if not sure.

Amaroo Aged Care Facility SURNAME GIVEN NAME BED NUMBER WING DIAGNOSIS DOB ALLERGIES OBSERVATION GOAL INTERVENTION EVALUATON/ OUTCOME Impaired mobility due to arthritis Optimise mobility as independently as possible. Have client assessed by physio. Provision of walker as per physio Slippers on when mobilising Removal of clutter Non slip mats in the bathroom Passive ROM exercises Implement falls prevention program. Client mobilising with walker without assistance- no falls this week. KP

Home & community Care See example of service provision plan You should always refer to your supervisor to gain clarification, more information or if a clients needs have changed. Your supervisor is there to help you. It is important that a clients routine, beliefs and customs are respected in the delivery of services and care. Remember that at all times a clients independence needs to promoted at all times, all older people deserve to feel in control of their ADLs and the help you are giving them.

Respect Always ask for permission before entering a clients home, using a clients belongings or before you undertake any care or service delivery. Always ask the client when, where and how they would like to receive their support.

As a worker you may be required to use a variety of equipment- you need to ensure you always abide by the p & p of your organisation. Make sure the equipment is good working order before use- this may be a microwave or washer in the home to a mechanical lifter in a residential care facility. Always undertake a risk/hazard assessment prior to undertaking the task. If not sure always ask your supervisor. With transport- ensure you have undertaken the required training in moving clients in & out of vehicles/ their equipment or hoists in transporting people in wheel chairs for example. Ensure you have all OH & S training to ensure safety of your client and yourself.

Assessing an older persons ability to undertake ADLs An important part of our role to assess and observe the clients ability to undertake ADLs Remember the importance of modifying the task or environment to promote independence of the client A clients condition may be progressive- dementia A clients condition may be temporary- fracture It is essential part of our role to notice changes, report & document these changes according to p&p. Activity: diagram- Id needs.

Ask & observe When you notice changes or a client voices complaints of changes such as pain/ increased stiffness for example..be sure to question further to gain more information. Be careful how you ask the question- they may feel embarrassed that can no longer do a task... “Do you need some help with the washing? Instead of “why haven't you done your washing? Another way to establish changes is to review the care plan and progress notes.

Reporting changes Reporting changes is essential part of communication for the provision of care- as you are one part of the multidisciplinary team. Reporting may be in the form of f:f, telephone, care notes/ progress report and hazard/incident reports. Activity- complete hazard/ incident & progress notes.

Supporting the older person to modify activities to adapt behaviour Once a change has been identified and reported then a modification in service delivery may be required. An activity may be adapted with the help of an OT or PT to optimise the clients independence. Finding out about aids and equipment can be via information centres such as ‘Independent Living Centre’ website- www.ilcaustralia.org.au Equipment may be such as tap turner, long handed broom, non slip bench mats, grips, large print, trolleys, walking sticks, alarms..... A client may need an increase in services to support their ageing in place or they may require placement into an aged care facility.

Safe & Secure environments Supporting the older person to maintain their environment may involve the client to assess for safety risks and identify strategies to assist them undertake ADLs easier. Helping the older person keeping their environment secure; prevention of falls, clients have control over ADLs- i.e.. A client with dementia may feel more secure with notes to jolt memory; and clients are fully informed. Talk with your client to ensure they feel safe & secure and discuss ways which may be adopted to assist a sense of security.

Adapting environs for safety & security Safety refers to being free from risk of harm, injury and danger. Adapting an environ for safety may mean- checking locks, removing hazards, checking equipment, assisting clients to pay bills on time, keep apt’s, temperature comfortable, shop regularly for healthy food. Ensure clients are aware of external potential dangers such as curbs/ footpaths. It is essential not to upset a client in the process of adapting the environment & to involve them in the decision making process, even if they do not want to adapt a necessary change such as clutter or purchasing a new chair.

Loss To cease to have something that has been a normal or desirable part of life.

Grief An intense emotional response to any significant loss, especially the death of a loved one. Grieving is part of adapting to loss.

Experiencing loss & grief Chaotic and disordered thinking ‘Super-drive’ efficiency to deal with emergency Dreams and nightmares Loss of interest, aimlessness Loss of concentration or inability to remember detail Loss of faith, hopelessness Suicidal ideas Pleasure in remembering Changing values and beliefs.

Physical Reactions Headaches Sweating, shaking Nausea Shortness of breath Over sensitivity to noise Loss of energy Aching muscles Dizziness and disorientation Loss of appetite Insomnia Increased incidence of infections and common ailments Pain that imitates illness or pain experienced by a loved one Stress related disorders.

The Stages of Grief The five Stages of Grief were originally defined by Elizabeth Kubler-Ross. These five stages have come to be identified with the general experience of grief.

“This can’t be happening – it’s not true” Denial people may seek second opinions, or refuse to discuss the situation. Denial allows the person time before they have to start dealing with the loss.

“Why me, why is this happening?” Anger when the person begins to realize the severity of their loss and becomes angry. The person may feel isolated or cheated.

“If I eat healthy food…give up smoking…?” By bargaining with medical staff, God or their own concept of ‘fate’ the person may try to regain control of the situation.

“There’s no point” Depression occurs as the person realizes the severity of the loss. They may feel completely powerless and unable to take any action on their own behalf. There is a feeling that life is over.

OK, this thing has happened – what do I do now?” Acceptance occurs after having worked through these emotional responses the person is ready to start the often long and slow process of adapting to the loss. The negative emotions from the early stages of grief are likely to recur from time to time.

Grief is not a problem to be solved but a process to be experienced.

Tips for Supporting the grieving person Being There Listening Reminiscence Relaxation Ritual Structure Opportunity

Ground Rules for Interviewing People who are Grieving Their experience will be significantly different from your own. Create a safe emotional environment Listen more – talk less! Listen to the client’s tone of voice Look at their body language Accept the person the way he or she is at this moment. Encourage the safe expression of feelings. Reinforce personal responsibility and choice

What to say “Tell me…” “Tell me what it’s like for you…” “Hearing that makes me feel…” “I feel I want to know…” “I’d like to hear about…” “I feel…”

What not to say… “Be brave” “Lets not talk about this, what did you do the other day?” “Just remember the good times” “You’re going through the angry stage, it will pass” “If I were you I’d…” “You’ll be stronger for this” “Why don’t you try…” “Time heals all wounds” “When I…” “I know just how you feel”

Grief and loss will be discussed further in the palliative care and emotional and psychosocial wellbeing units.. References: Aged Care text & Aspire learning resources.