Unit82 - support individual at home PDF

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Unit 82: Support individuals to live at home 1. Understand the principles of supporting individuals to live at home

1.1 Describe how being supported to live at home can benefit an individual Supporting individual to live at home helps promoting and encourages their independence. Whether individual is in their own home or supported accommodation (sheltered living) they can maintain or gain greater sense of normality, have more time to spent with loved ones or more likely to get visits from friends and family. Individuals will be able to maintain more control and choice over daily routines, living surrounded by their personal possessions with which can hold fond memories. Being supported in their own homes, means having less interruptions or noise from other residents of the house. Support for individual promotes their independence and physical ability and encourages individual to maximize their own potential, helps maintaining their rights and choices, helps in maintaining their privacy. As a rehabilitation support worker my role is to provide positive encouragement, support and practical help to enable clients to reach their full potential in terms of personal independence and quality of life. The aim of the job is to support and advise people affected by neurological conditions and assist them in identifying and working towards goals for their future. 1.2 Compare the roles of people and agencies who may be needed to support an individual to live at home In planning interventions, it is important to use an approach, including both mental and physical factors and provides holistic person-cantered care for the patient. Services are to enable patients to reach their full potential in terms of personal independence and quality of life. Care workers: Attending to and assisting with the activities of daily living including dressing, toileting, taking medication, eating (or preparing meals), helping to attend personal hygiene, helping in promoting resident’s self-esteem, and maintaining their personal environment and personal effects. Physiotherapists: Physiotherapist can assess the extent of any physical disability and draw up a treatment plan. Physiotherapy will focus on areas such as exercises to improve muscle strength and overcome any difficulties with mobility, to help individual be as independent as possible in the home setting. Occupational therapists: Occupational therapist can assess your ability to carry out everyday tasks and find ways to manage any difficulties. Occupational therapy may involve adapting your home or using equipment to make everyday activities easier, and finding alternative ways of carrying out tasks you have problems with i.e. dressing up, preparing meals, personal hygiene. Returning to hobbies and interests is an important part of rehabilitation (activities can be adapted to enable carry them out) Speech and language therapists:

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SLT can assess patient’s cognitive functions. Patients can be taught techniques to help them relearn and recover communication skills (problems with speaking and understanding, as well as reading and writing). This may involve exercises to improve control over speech muscles, as well as using communication aids (such as letter charts and electronic aids) and alternative methods of communication (such as gestures or writing). SLT can also help in managing swallowing problems. This may involve tips to make swallowing easier (such as taking smaller bites of food and advice on posture) and exercises to improve control of the muscles involved in swallowing. Rehabilitation support workers / Keyworkers: Rehabilitation support workers are carrying out a rehabilitation care plan designed by a qualified member of the multidisciplinary team, to meet the individual patient’s needs. Support workers are to provide emotional support and encouragement to patients (depressed, upset, angry, frustrated about their change in functional ability and increased dependence). Keyworkers build up a professional working relationship and trust with the patient their family or carers. They are to encourage patients to re-establish social networks to help reduce social isolation. (appropriate referrals for patients in liaison with the team leaders) Social workers: Social services can provide help with necessary care arrangements (personalised care packages for individuals at home, or appropriate shared/supported living accommodations for less abled), equipment and aids to use in your home, free or subsidised travel on public transport, or financial support (i.e. to help getting around, to look after yourself, towards the rent). Psychologists (talking therapies): Counselling services aim to talk about thoughts and feelings and to come to terms with what has happened. It gives opportunity to look at how the condition has affected life and discover ways of moving forward. Specialist nurses and doctors: Health care professionals can offer information, advice, support, and treatment to individuals. GP’s or district nurses are the first point of contact with the health service. GP will be able to: prescribe medications, liaise with district nurse regarding individuals care at home, refer to specialist’s services i.e. dietitian, diabetic nurse, continence services ect. To help individual remain at home, GP may also arrange for district nurse, to visit. The team can: give injections and change dressings, help with wound care, provide bowel and bladder care. Support groups (specific to the condition): Reducing social isolation and meeting other people with similar problems can be very beneficial for patients as well as the family. Local support groups gather people to share personal experiences with and receive practical support and advise. Meeting people on the regular basis is an important source of well-being. 1.3 Explain the importance of providing information about benefits, allowances and financial planning which could support individuals to live at home Most of people want to live independent lives in their homes for as long as possible. There’s a variety of support services available to help individuals to do this. People have the right to know what support is available to them. Social workers, independent agencies offer help with financial planning, access to welfare benefits or to explore possibility to live in supported accommodation. Benefits can help cover i.e. the extra costs of disability for disabled people and their families. Some benefits and tax credits are not just for disabled people but may provide extra money if you have a low income. Housing benefit is help with rent and some other

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housing costs. This can help the individual to stay in the comfort of their own home, without the need of being moved to i.e. supported living facilities. 1.4 Explain how risk management contributes to supporting individuals to live at home The risk assessment process is not about creating amounts of paperwork; it is about identifying and taking sensible and proportionate measures to control the risks and to help deciding whether there can be done more. It is about Identifying risks and finding the most suitable way of making them as safe as possible for the individuals. Risks assessment is associated with: personal needs and health, social situation and lifestyle, financial circumstances, security, environment or legal status. These are essential part of the risk assessment to support persons needs and to promote a safe way of living. It is important to consult with the individual and the family and friend and identify, within the risk assessments and support plans, procedures, practices, equipment and number of staff required to safely manage risks associated with:  personal care or other activities to achieve  manual handling tasks  meeting the individual’s preferences for maintaining their independence and living at home  gaining access to, and ensuring the security of the individual’s home It is important to identify and create:  the procedures and practices for maintaining and recording new risks associated with equipment, appliances, fixtures and the premises,  the resources and procedures that need to be in place, and how they will be regularly monitored, to minimize the risk of accidents, injury and harm to individual’s family, friends and carers,  the agreement of how, when and by whom the risk assessments and support plans will be implemented and reviewed 2. Be able to contribute to planning support for living at home 2.1 Identify with an individual the strengths, skills and existing networks they have that could support them to live at home The way of recognising the strengths, skills and existing networks is through active participation. Active participation supports an individual’s right to take part in the activities and relationships of everyday life as independently as possible. Their needs might include:  Personal  Physical  Financial  Social  Environmental  Safety The individual is regarded as an active partner in how their own care or support is done, rather than a passive recipient, an individual service user can set own goals and achievements to help them build up their strengths, skills and education all of these are recorded in the personal aims goals and achievements file (personal care plan).

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2.2 Identify with an individual their needs that may require additional support and their preferences for how the needs may be met Sometimes individual will require additional support to be able to live at home. It is important to identify and plan with the with the individual, family and friends of how to additionally support the person in regards to:  i.e. extended security of the house (i.e. key safe if individual unable to open the door for health care professionals and care workers)  changes in the individual’s health (deterioration, is the individual still safe to live in the house or requires increase in care package)  difficulties with individual’s mobility and transfers (is individual able to mobilise unaided or requires appropriate equipment i.e. profiled bed, toilet frame, sliding board, hoist)  difficulty with speaking/hearing (does the individual need specialist equipment to communicate)  difficulties in performing activities of daily living (does the individual need specialist kitchen appliances – profiled cutlery, perching stools to rest)  difficulties in going to the toilet (does the individual need referral to continence services)  changes in the individual’s skin condition (does the individual requires pressure relieve cushions or mattresses, advise on skin care or visit from tissue viability nurse, dietitian) In the case of any changes or problems which arise while individual is in our care, it is important to report any changes to the circumstances and any problems we might came across, and report it to the line manager/supervisor. It is significant to communicate with the individual in their preferred language, and be aware of any language barriers (cognitive barriers). Support from the family and friends is essential in order to help in communication with the individual or to identify ways of communication with the supported individual (sign language, other nonverbal forms of communication). 2.3 Agree with the individual and others the risks that need to be managed in living at home and ways to address them It is important to identify and risk assess with the individual and family and friends all the risks that the person can come across and the ways to manage them. Majority of the clients I am working with are vulnerable and at risk of intruders. Elderly people or those with learning difficulties, are often trusting and do not able to challenge and scrutinise a visitor’s identity. Always advise the person to look for the organisation’s name badges in order to identify and verify the visitors. Also it is a good advice never to open the door for the people who did not make prior appointment with the individual. Open windows can entice unwanted intruders. Advise the individual to always keep the windows close over night or when living the house. Keysafe’s pin number should not be disclosed to people not involved in care of the certain individual. Staff should always ask for consent from the patient to disclose the pin number to other health care professionals. Individuals need to be advised on the security measures in case of fire, i.e. when they are still able to prepare their own meals. Family, friends and supporting staff should always make sure or involve individual in checking if the gas/electric oven is always turned off.

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Medication taking may also pose the risk to some of the individuals. Medications come in the similar boxes and very often the labelling on the boxes is in the small print. Patient van get confused of what medication to take and in what quantity. It is useful to request from the GP for the medication to come in a useful blister pack, so the individual can be independent with their medication. It is significant to communicate with the individual in their preferred language, and be aware of any language barriers (cognitive barriers). Support from the family and friends is essential in order to help in communication with the individual or to identify ways of communication with the supported individual (sign language, other nonverbal forms of communication).

3. Be able to work with individuals to secure additional services and facilities to enable them to live at home 3.1 Support the individual and others to access and understand information about resources, services and facilities available to support the individual to live at home As a rehabilitation support worker I need to build up a professional working relationship and trust with the patient, and their family or carers, through visiting them on a regular basis, and providing feedback regarding progress or difficulties. My duties are to source and explain information/resources from the external agencies, voluntary sector, benefits agency and other health and social care providers available to meet patients’ needs and enable them to live at home, as well as to communicate information regarding the patient’s illness and rehabilitation plan, to encourage them to participate in the rehabilitation programme, using persuasion, reassurance, tact and sensitivity. 3.2 Work with the individual and others to select resources, facilities and services that will meet the individual’s needs and minimise risks As a rehabilitation support worker I make appropriate referrals for patients in liaison with the team leaders, to appropriate services i.e. occupational health if patient in need of equipment or requires assistance with activities of the daily living, or Speech and Language Therapist when patient has difficulty swallowing or communication. Advise to contact social services (or making referral in behalf of the patient) is possible, if individual requires i.e. more social care input, increased package of care or application for 24 hours continuous care. Rehabilitation support worker is also to encourage patients to re-establish social networks, or to take up opportunities offered by social services, leisure services or the voluntary sector, to help reduce social isolation and to encourage ongoing activity. Very new referral needs to be discussed, agreed with the individual and family. Permission to share information needs to be signed by the patient (if no capacity, by the Next of keen) and placed in patients file (uploaded to electronic system if required). 3.3 Contribute to completing paperwork to apply for required resources, facilities and services, in a way that promotes active participation

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As a rehabilitation support worker my role is to assist patients and the family to complete or assist in completing or to make telephone calls to access services (e.g. telephone shopping, diala-ride), as appropriate. It is important to discuss the extend of the help with the patient, whether patient able to i.e. fill the application form by themselves, required instructions or need us to fill the form entirely (if the form is accessible in electronic version only). Permission to access sensible information and agreement from the patient to fill the form is essential, should be documented and appropriate permission should be signed by the patient or NOK if needed. 3.4 Obtain permission to provide additional information about the individual in order to secure resources, services and facilities Always ask the patient or the NOK whether we can pass the information about the patient to other involved services. Explain and reassure patient and NOK that the sensible data will not be passed to the party not involved in the care, that the information is safe and protected. Document the permission in patient’s file. Patient also must sign the Permission to share information, and this legal document needs to be placed in patients file (or uploaded in its electronic version). 4. Be able to work in partnership to introduce additional services for individuals living at home 4.1 Agree roles and responsibilities for introducing additional support for an individual to live at home As a rehabilitation support worker I am integral part of the multidisciplinary team and in my role I am expected to work with the service manager, clinical lead, therapists, health care assistants, nurses, social services, voluntary sector, community support groups, service user, carers and any other individual relating to the service. When designing person centred care plan to support individual to live at home, roles and responsibilities are being agreed with the patient. Care plan also should clearly state who to report to with any issues. Names and contact numbers (for the keyworker, social worker) could be given to the patient and family. 4.2 Introduce the individual to new resources, services, facilities or support groups During the initial assessment, therapist discusses the expectations and goals with the patient and the family, to identify the best possible care and patients needs. At this point it is important to explore, to source and explain information/resources from external agencies, voluntary sector, benefits agency and other health and social care providers to meet patients’ needs. It is useful to have leaflets with the information that might interest patients (i.e. community support groups, voluntary sector, charities, taxi card, dial a ride card) or offer to print information for the patient and bring for the next visit. 4.3 Record and report on the outcomes of additional support measures in required ways

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Every patient’s contact, direct or indirect, should be recorded in appropriate patient’s notes (either paper copy stored in patient’s file or electronic version), within 24 hours from seeing the patient. Every change to circumstances should be not only recorded but reported to the keyworker, lead therapist or supervisor.

5. Be able to contribute to reviewing support for living at home 5.1 Work with the individual and others to agree methods and timescales for on-going review During the initial assessment of needs and patients centred care planning it is essential to discuss with the patient and the family how and when to review the progress of the identified goals and interventions carried out. Both parties must agree on the time scale for reviews and methods of monitoring how the care plan is working. Patient must be also aware that in case of any change of circumstances they need to inform therapist straight away, so than the new care plan could be drawn. 5.2 Identify any changes in an individual’s circumstances that may indicate a need to adjust the type or level of support As a rehabilitation support worker my role is to monitor patients progress towards their goals. In case of any difficulties in achieving goals or changes in circumstances my duty it is to report it to the therapist in charge to readjust rehabilitati...