Combined Units

Combined Units Provide support to an older person Provide support to meet the emotional and psychosocial needs of the older person Provide support to maintain independence

Respect To hold in regard. Avoid degrading, insulting, injuring or interfering with or interrupting Treat with consideration

Courtesy Polite or considerate in behaviour or wording. Courteous behaviour (kindness)

Trust Firm belief in a person or thing which may be relied upon. Feel sure of the loyalty Without fear

Privacy Not open to the public domain Seclusion, keeping matters to themselves Only shared in confidence with ones they can trust

Dignity Claims to respect one wishes, rights and privacy Suitable behaviour which does not degrade another

Confidentiality To keep private unless it impinges on another’s health or safety Keeping a secret, unless it is required to be disclosed by law or above.

Ensure self-introduction occurs appropriately Self introduction is important when working with anybody, Our culture and indeed many cultures consider it rude, so be aware that clients you work with will have an expectation that you greet them in a way that is respectful to them. No one wants to be treated with intentional or unintentional disrespect. No matter how busy you are or how hectic it gets there is no excuse for rudeness and disrespect.

Ensure self-introduction occurs appropriately You will probably find that over time as you get to know the clients better, you may change the way in which you greet them. The best you can always do is maintaining the respect of the person at all times. If you feel uncomfortable in being respectful, that’s your problem!

Principles of Effective Communication Maintain courtesy in all your interactions Listen and respond with empathy Observing and listening actively at all times Respect the individual differences of each person Maintain a non-judgemental attitude in all care situations.

Most of the breakdowns that occur in relationships and in communication do so as a direct result of people choosing to ignore these principles. The principles that will apply when you are communicating with people are maintaining self esteem, listening and responding with empathy and involving the other person.

Maintain self esteem Our self esteem is made up of all the attitudes and beliefs that we have about ourselves. It is the total picture we have of ourselves, or the way in which we see ourselves. Interactions with others shape our self esteem. From the way that other people treat us we learn if we are liked or not liked, a success or failure, acceptable or unacceptable.

Maintain self esteem A person’s self esteem also affects the way they communicate with others. A positive self esteem is necessary for healthy and satisfying interactions. A person with poor self esteem may feel inadequate, inferior or unworthy. This often results in difficulties in communication, expressing their feelings and voicing opinions different from those of other people.

Maintain self esteem People have the best chance of developing an effective message when they understand the other person’s point of view Since many people have difficulty clearly expressing their thoughts and feelings the ability to imagine how things might look from the other person’s point of view is important

Listen and Respond with Empathy People have the best chance of developing an effective message when they understand the other person’s point of view Since many people have difficulty clearly expressing their thoughts and feelings the ability to imagine how things might look from the other person’s point of view is important

Listen and Respond with Empathy Some people say that empathy is listening with the heart as well as the head. When you listen and respond with empathy you do more than just absorb the other person’s words. You also try to put yourself in the other person’s shoes, to see the world through their eyes and to experience their feelings.

Listen and Respond with Empathy Even if you disagree with the other person’s position, responding with empathy is likely to boost your knowledge of what the other person is communicating. Empathic responding also maintains the other person’s self esteem. It suggests that the listener is willing to accept the speaker as they are, without judgement. This in turn tells the speaker that their communication is worthwhile and encourages a relationship of trust.

Have you ever experienced a conversation where you couldn’t get a word in? Or perhaps felt left out of the conversation? How did you feel?

As a carer you will be involved with many short and long interactions with your clients such as;

Short interactions will include When you are assisting with morning and afternoon tea you may be expected to bring in the light refreshments and check to see if the clients are able to manage, Obtaining the clients selection from the menu for the following day etc.,

Longer interactions will include Assisting the client with their ADL’s in the morning Preparing clients for bed

As a carer you need to be aware of how a person’s disability can affect a person’s ability to communicate.

Dementia They have trouble remembering names of familiar objects or people They can describe an object but not be able to name it They have difficulty saying the right word, substituting a similar word. E.g. saying walk instead of wake

Dementia They may quickly forget what has been said They may not understand because the words so not have ant meaning to them. E.g. discussing television when they do not remember what a television is.

Unfortunately communication difficulties can often result in frustration and the person becoming more withdrawn and isolated. To improve your interactions when communicating with people with dementia, try the following approaches

Make sure you have the person’s attention. Touch them lightly, or call their name. Obtain eye contact Speak slowly and use simple words. If the person cannot think of a word ask them to describe or point out the object. Allow plenty of time for a response. Ensure eye contact if you need to repeat the question. Present only one question or idea at a time. The person may forget the first part of the question if you ask more than one thing at a time

In addition Always assume that the person can understand more than they can express. Never talk about somebody in front of them Treat the person with respect and as an individual Non-verbal cues such as photographs or objects may assist the person to understand. E.g. bringing the fruit bowl over when asking if they would like a piece of fruit.

Generating a Trusting Relationship Trust is a difficult thing to earn. It can take ages to be accepted by the people you work with and also the people you work for.

Trust Trust is often established after a period of time where interactions between people have gone well enough for each party to be comfortable with each other. Fast familiarity and respectful interactions may not lead to the acceptance of each person. It is your job to ensure that the interactions you have with everyone is based on sound principles that lead to the generation of trusting relationships.

Generating Trust Is usually based on democratic principles of interaction which include Courtesy Listening and responding with empathy Non-judgemental interactions Observing and listening with empathy Respecting the individual differences of each person

Barriers to Generating Trust Barriers to generating a trusting relationship are quite obviously linked to interpersonal interactions and in particular communication

Physical barriers to effective interpersonal communication may include Noise Temperature Time Distance Light Positioning of furniture etc

While barriers in communication can generally be seen as either you or the older person not understanding each other, this can take the form of Difficulty understanding the language being used Difficulty with non-verbal gestures and signs The emotions of both you and the other person

These factors affect how we attend to the speaker or message deliverer. Attending consists of a number of skills or behaviours, including facing the person, giving them your full attention, adjusting your speech and non verbal behaviour in line with their feedback etc., to show you are listening and not just hearing.

One very important factor to deal with is emotion. If you ignore this, what message are you sending?

Face the person and watch their body language for non verbal signs, as they convey many things. Body language is complex and is a topic in itself. But by maintaining an open position we can provide encouragement to the other person.

Don’t forget that older people may have the perception that you may not do what they want or need, or you may remind them of a bad experience so may fear you. They may also have altered perceptions, as is often the case with people with dementia.

You will need to consider the barriers on an individual basis in order to ensure you can be effective in building up a trusting relationship with the people you are supporting . At times you may not “gel” with the person and that can’t be helped. Not everyone gets along with everyone, it’s a fact of life. Don’t take it personally if you don’t get along

Taking into account the physical changes associated with ageing when delivering services Aides and Support

Advancing years The decline in strength and muscle ability is long and gradual; there are even gratifying plateaus At the age of 50 a man still has about 4/5 of the muscle strength he had when he was 25. Although physical abilities may decline, mental abilities may actually improve during the middle years, and the ability to learn can remain keen, provided the person is in the habit of learning .

Advancing years It is especially important in later years to have regular medical and dental check ups, sufficient exercise, adequate rest, nutritious food and a positive mental attitude. Sensible moderate exercise in line with physical capacity can give a sense of general well-being. It is important on these occasions to do some easy stretching, pulling and rotating exercises during the warm up period.

Certain needs remain constant throughout life, needs such as Security good health, income and a recognized role in society Recognition as an individual with you own abilities and personality Belonging as a member of a family, social group and community Self-expression by developing abilities and talents in new areas at new levels Adventure new experiences, new sights and new knowledge

The typical physical changes that occur but not necessarily always present are generally well known and can be identified by physical features such as Wrinkles, grey hair, thickening torso Decline in senses (taste, poor nutrition) sight, hearing recognition time Arthritis- painful, limiting movement can lead to disability Declining elasticity in body tissues

As a care worker your role requires you to provide support to older people and maintain their quality of life. To do so you need to be quite clear with what you mean by quality of life in the broadest and most objective sense.

To assist you in delivering an optimum service you will need a deeper understanding of a number of critical areas such as understanding the physical and psychosocial aspects of ageing and knowing what strategies may be required to promote healthy lifestyle practices

You will of course need to be aware of what the physical changes associated with ageing are when delivering services and supporting. This will have a huge impact on care choices and decisions; however should not interfere with the person’s interests and life activities which should be at all times be accommodated There will be times when the older person will need to be assisted to recognize the impact of the physical changes associated with ageing.

Physical changes associated with ageing may have an impact on their activities of living. We should however remember that it is a service provider’s role to ensure measures are put into place to minimize the impact through the use of adaptive equipment and environmental modification. Discuss the care needs of the aged person with them. Encourage them to look beyond the definition of just personal care

There are many different support requirements people have such as Physical, sexual and emotional Support and care Financial Household assistance and maintenance Religious Spiritual and Ceremonial Cultural Recreational Social

Assisting in Maintaining Lifestyles Assistance is promoting and maintaining an older person’s healthy lifestyle can be achieved in many ways. The most important is to have a clear understanding and belief that an older person deserves a healthy and fulfilling lifestyle just as you believe you so. Avoiding negative labels and stigmas about the older person provides a positive approach and this in return supports equality and respect within your relationships.

The older person must become aware that they are consumers of community services and have choice in selecting services that suit them With the focus on the older person as the consumer and not as a welfare recipient people will begin to see that they have equal rights as any other consumers have. This will provide an opportunity for the person to maintain their lifestyle with greater confidence. Providing guidance, personal assistance and participative activities can encourage a healthy and positive lifestyle, with choices and participation in the community.

Benefits for E ncouraging H ealthy Lifestyles The benefits to a person in being engaged in meaningful healthy activities and habits are immense Most importantly a person has the opportunity to maintain a normative lifestyle, continues to interact with the rest of the community, continues to learn through their personal choice of education and participates in leisure and sporting activities The successful involvement in activity must be based on their choice and not that of the service that is involved in supporting them

Benefits for E ncouraging H ealthy Lifestyles Sound; mentally and physically from their participation in activities of their choice can be maintained and supported A workers role is to encourage independence and choice and to facilitate or provide services so that a person may actively take part in a lifestyle of their choice

Benefits for E ncouraging H ealthy Lifestyles The person’s involvement with these community activities gives them a positive image and valued social-roles. Participation promoted new friendships and relationships and keeps them in touch with family and friends. This is very important to the maintenance of a person’s physical and psychosocial well-being.

Strategies that assist the older person to promote a healthy lifestyle The older person should be able to live a normal and healthy life comfortably in their own home or in a homely environment within their local community. The carer should ensure the person’s home has been suitably adapted to meet their changing needs.

Strategies that assist the older person to promote a healthy lifestyle This can be achieved by providing the person with personal care assistance with their grooming, health and hygiene, medication and with domestic home duties. This may also include providing care assistance for any pets the person may have, (if in home care)

Strategies that assist the older person to promote a healthy lifestyle An important role of the carer is to assist the person to maintain contact with family and friends. This can be done by involving the family with the person’s day to day living requirements such as decision making, recreation and social life. Only if they want family/friends involved they have the right to refuse contact.

Support should be provided to the person to have their concerns and or complaints heard and acted upon by sharing their information, with their permission , with an Aged Care Advocacy Service. This service will then provide the person with information and advice and may support or even represent then too ensure their concerns and complaints are heard and dealt with in the most appropriate manner.

Healthy lifestyle habits Personal Care Showering Elimination and maintaining continence Preventative health care Monitoring and maintenance of current health issues

Healthy lifestyle habits Personal grooming Dressing and shaving Oral hygiene Eye care Nasal care Ear care Hair care Skin care

Healthy lifestyle habits Physical activity and exercise Nutrition and mealtime habits Personal hygiene Leisure and recreational activities Building and maintaining relationships Continuing meaningful cognitive activities Rest and sleep Community participation Personal development and education

Provide support to the older person to maintain social and community networks Each older person should be given the opportunity to participate as fully as possible in making decisions about the events and activities of his or her daily life and the services he or she receives.

Participation and I ntegration Each person should be supported and encouraged to participate and be involved in the life of the community It is your role to ensure that the person has the opportunity to develop and maintain skills and to participate in activities that enable him or her to maintain and protect their valued roles in the community

Participation and I ntegration Without a focused effort, older people will be at risk of losing their social network, so then it becomes limited to the people whom they live with, support workers and possibly immediate family. These relationships may be impersonal, temporary or forced as transient (respite) clients move in and out of the residence, employees transfer to other worksites or positions and a host of professionals are involved for short periods. Family involvement varies considerably dependent on proximity, the manner in which the family is received and the attitude or relationship of individual members towards the person.

Participation and I ntegration As a strategy to increase the level of participation, opportunities for contact with a range of people in typical situations should occur. Valued activities provide the opportunities and experiences for people to meet and for a variety of relationships to develop. The role of the support worker is to create these opportunities, assist in fostering and maintaining new and existing relationships and to be able to withdraw as support needs decrease.

Integration is D ependent on Physical Presence (being there and doing it through) Living in the community Participating in recreation/clubs and groups Using community facilities Shops Financial institutions Adult education centers Libraries etc.

Integration is D ependent on Positive image (behaviour, ability (with or without assistance) and appearance Physical appearance of the person in relation to clothing, hygiene and suitability for activity/venue Behaviour is appropriate as to not draw attention to the person not being different Level of assistance provided enables optimum participation and demonstration of abilities

Integration is D ependent on The appearance and conduct of you also impacts on the preconceptions of other participants as to their attitude and rapport established with an older person. It is imperative that you foster a positive image of both yourself and the person you are supporting.

Social Isolation Social isolation has a profound effect on many older people It adversely affects their health both physically and mentally.

If social isolation is reduced It can contribute to maintaining or improving their overall health. Increased social activity tends to improve the persons health thereby reducing the need for medicinal resources. Social interaction is necessary to alleviate boredom, loneliness and unhappiness.

Causes of Social Isolation Loss of mobility due to ill health Restricted travel Fear for personal safety Emotional pressure and time if performing the role of a carer

The individual’s social networks should be established in consultation with the individual, their relatives, friends, carers and others with a vested interest in the person’s well-being

We need to consider Tailoring a social program to the individuals needs Ensuring transport arrangements can be met The persons personal safety Increasing the persons confidence and self esteem Information and referrals to health professionals, the services and activities they provide

There are three groups of support and social classifications They are support networks, community networks and appropriate people or agencies.

Support Networks Advocates Family Carers Friends Clergy and other pastoral providers

Community Networks Ethnic organisations Clubs Community centres Support groups Recreational groups Voluntary organisations Veterans and war widow organisations

Appropriate people and/or organizations Supervisors Health care professionals Clergy or pastoral providers National associations (Palliative Care Ass., Grief and Loss Ass., Stroke Ass., etc) Support groups Veterans and War Widow Organisations Advocate Office

Helping a person who is older to gather information about what is available in the community is a good starting point to increase their involvement. Having information which makes sense gives confidence to do things and move around the community. It is also important if people are to have choices and make decisions.

For example making a map of the local area is a good way to help a person discover what is available in their community. Start by helping the person to draw their home and then plot out all the other things the person uses and the things of interest in the local area. Starting up a scrapbook of places they might want to go or things they wish to be involved in is also helpful for encouraging choice and decision-making. Collecting advertisements, menus, business cards and timetables can aid memory, recall and decision-making.

Being part of the community also means getting to know other people and joining in local community events. As members of the community we rely on others to help meet our needs. Because we are also human beings we often need to spend times with other people and to have friends and acquaintances. This process of becoming involved is often called networking.

Why are Social Networks Important? Regular social contact with others who are significant in our lives and whom we value cannot be underestimated. Human beings have an in-built desire for relationships with other human beings. These provide us with the foundations upon which we establish the quality of our lifestyle. Our relationships and networks with others have both a direct and indirect influence on how we see the world and ourselves. This in turn prejudices how we meet a life time of needs, both for ourselves and for those with whom we have contact.

Why are Social Networks Important? Networks and relationships give rise to ties with the community and feelings of being included. In your role as a Personal Care Worker you have a responsibility to support people to be included in their communities. Being a member of a community is much more than living in the community and using community facilities. It is also about belonging.

Networking is based on the understanding that all people have capabilities, strengths and talents and these are used to assist and support others as needed.

Basic needs for survival Safety Food Shelter

To improve the quality of our life we must also have needs in other areas of our lives met. Individuality Choice Physical and Emotional Well-being Challenges Risk taking

Most peoples’ networks are interrelated and do not exist alone. They encompass all aspects of a person’s life and interweave through all of our life domains to provide us with a comprehensive support system that adds to the quality of life. So it can be said that our networks are related to our employment, education, friendships, recreation, health, family and just about every other aspect of our lives.

Ask yourself How many social networks do you have? What are they like?

Social & Recreational Activities We need to recognize the need to modify or adapt social and recreational activities to meet specific needs of the older person and report and report it to the appropriate person.

Social & Recreational Activities Due to physical and mental deterioration that occurs during the aging process it may not be possible for a person to fully participate in some social or recreational activities without adapting them to suit their particular needs. This may not be evident at first but in time should become apparent to the support worker who must get it addressed.

Suitable Activities Memory and concentration skills Relaxation Pleasant events (Social drinks or outings) Special events (Birthdays, Weddings, Parties)

Activities to Stimulate Cognitive Abilities Crossword puzzles Shopping trips Cooking Playing musical instruments Reading Board, card and computer games

If a person is having difficulty with an activity do not just stop them participating. There are usually many ways in which the activity can still be pursued using some piece of adaptive equipment.

Where you believe a person is not participating in an activity try to find the true reason. If it is a physical thing report your findings to the appropriate authority and try to get it corrected.

It could be a simple as getting a hearing aid, a new pair of glasses, having a handrail fitted because the person is frightened of falling, getting special shoes made or giving one on one support.

Impact of aging on the individual’s emotional and psychological well-being There seems to be a strong link between a person’s social and mental activity and their physical well-being With aging some people seem to loose their identity and must be given the opportunity to reminisce and review their life. Motivation declines due to the lack of stimulation and possibly the perceived value of the task.

There is a need to practice, maintain and learn new skills and areas of interest. We need to ensure that the older person is involved in the decisions that affect them, know the full range of options available and have input into their implementation

Common Emotional Disorders that may affect an older person includes Anxiety: a feeling of apprehension, dread or unexplained discomfort, associated with a sense of helplessness arising form internal conflict. Depression: a term which can be used to denote a serious disorder of mood. Feelings of sadness dominate which are accompanied by psychosomatic features.

Common Emotional Disorders that may affect an older person includes Bi Polar / Manic depressive disorder: a group of reactions whose main characteristics is mood swings ranging from profound depression to acute mania, interspersed with periods of normality Phobia: an intense fear of some situation, person or object so that the danger is magnified out of proportion and may result in panic attack.

People who develop a mental illness face isolation and discrimination, in addition to the unfortunate negative stereotypes of being an older citizen. These attitudes can force people to hide their illness or feel ashamed. They may find difficulties in communicating and keeping relationships

Emotions on Admission to Residential Care For most people, admission to residential care is unplanned and often unexpected, occurring because of a major event in their life. stroke, a fall, the death of a partner, or the inability of a relative to continue caring for them. This means that a resident will probably experience a range of emotions on admission

Positive Emotions on entering Residential Care Relief: that he/she is no longer a burden on carers or relatives Security: with the provision of accommodation, care and daily activities Freedom: from stress of running his/her own home

Positive Emotions on entering Residential Care Company: if he/she has lost a partner or is living alone Challenge: entering a new phase of life, new challenges to meet and master

Negative Emotions on entering Residential Care Anger: at having to enter residential care, at their own physical frailty, at their family and carers Grief and Loss: of a partner, home, independence, health, pets, possessions, of making all his/her day to day decisions

Negative Emotions on entering Residential Care Fear: of the quality of life ahead, regimentation and death Loneliness: at having left their old environment Despair: life will never be the same again, unwanted, forgotten or no longer useful.

Encourage and support the older person’s self esteem and confidence One of the most overpowering emotions an older person has is the thought of being a burden to their children and grandchildren. As their physical strength fades the things they used to do become difficult and they have a feeling of being of little use to society.

Encourage and support the older person’s self esteem and confidence This is the time when support form the family is most needed. The traditional role once held in society of passing on knowledge and wisdom has largely diminished with the advent of the information age. Computers are the main source for information retrieval by the young.

Encourage and support the older person’s self esteem and confidence Some older people tend to believe that the younger person cannot understand what they are feeling because they are not old. Sometimes there is a feeling of inferiority as the young are generally better educated than their elders. Speaking out and voicing their opinions could alienate them from the small attention they do receive.

Encourage and support the older person’s self esteem and confidence Quite often there is a fear of being left alone and pride does not allow them to communicate how they are feeling. Extending family values into the lives of elderly people allows them to feel wanted. Being involved in everyday workings of the family unit builds confidence that is synonymous with self-esteem.

The family does not have to be from their own bloodline, it can be old friends or new ones. They should be encouraged to look after one another, give each other support and the carer should encourage and steer them towards this goal. They may feel reluctant at first but the environment in which one lives can be very persuasive.

If professional staff work at creating this as normal those living with in the system will take up the challenge and retake some control over their lives. Care must be taken to allow for setbacks and mistakes will all communications being positive. Try to ensure every outcome is successful by letting the person adapt at their own pace

Three things determine how others react around us Thoughts Feelings Actions

People mirror others. If they are surrounded by positive expectations and attitudes they will respond in the same way. The positive outlook boosts a person’s self esteem and confidence strengthening their sense of identity and of feeling valued. This in turn helps maintain or even improve skill levels and abilities. Receiving only neutral or negative messages, the reverse is possible and can lead to disastrous consequences.

Older people must be supported or cared for in an environment that ensures their emotional well-being. There is a legal and moral duty for all care providers to project a feeling of security to those they are providing a service to. Activities and social gatherings alleviate the sense of loneliness.

They should not feel threatened or vulnerable. They should feel secure, contented and at ease to discuss any issues that are of concern. Any feelings of anger, frustration or anxiety must be reported and addressed in the appropriate manner. They must be supported through difficult times such as the grieving process to accept the loss and move on. Where necessary, professional intervention may be required

Normal displays of love and affection must not be stifled. Allowing people a degree of control over what happens to them, encouraging self-determination makes one feel good. There is a strong link between emotional fitness and physical well-being.

Ensure empathy is shown to an older person who is emotionally distressed Emotional distress is something we all fell at some time and it affects us all differently. The most commonly talked about emotional distress is probably external pressures rather than internal ones.

Most types of emotional stress results in some form of physical symptom such as sweaty palms, shortness of breath, tensing of muscles and chest pain. As the episode passes a person usually trembles as they relax. Other forms of emotional distress comes for within, such as Fear Anxiety Guilt Loneliness

These affect the person’s personality in different ways that vary from being withdrawn to outbursts of anger. If allowed to perpetuate, the person is invariably powerless to initiate change and will eventually give up or become embittered, resulting in poor quality of life.

As a worker in close contact with clients on a daily basis it will be up to you to observe the signs and symptoms of the emotional distress. Respond with empathy, not sympathy. You will also need to report this to your supervisor and anyone else who works with the client

Personal Care Workers need to ensure that they meet the emotional and psychosocial needs of the older person. If your attempts at providing support are clearly not meeting the person’s needs then you need to seek assistance from an appropriate person at your workplace.

The strategies for addressing the situation are formulated within local protocols by consultation with appropriately qualified staff. The support team implements and monitors results. Changes are made if the person improves or worsens.

Activity Left Hand / Right Hand

Loss and Grief Most people have experienced some sort of loss. Its important we provide a framework however for looking at loss

LOSS has been grouped into four major categories

1) The loss of a significant person: Death of a loved one is probably the ultimate loss, its final and complete; also desertion, separation, divorce, abortion and stillbirths fall into this category. Older people will have faced a lifetime often of loss of significant people.

2) The loss of a part of the self: Physical Structural loss : loss of a limb, loss of an organ, disfigurement, loss of hair, loss of teeth, any outward change, loss of body image (through surgery or burns or accidents) Functional loss: loss through stroke, paralysis, blindness, arthritis, infertility.

3) The loss of external objects Loss of possessions money, jewels, property and symbols of identity such as photo’s artifacts etc, through burglary, robbery and natural disasters such as fire and floods

4) Developmental loss Birth trauma, Weaning, Growing up, School, exam failures, School-to-work transition, Leaving home, New relationships, Marriage, Old age and multiple cumulative losses

Combined Units

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Combined Units