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Training Division

CHC30212 Certificate III in Aged Care

CHCAC318B

WORK EFFECTIVELY WITH OLDER PEOPLE

Learning Materials

TABLE OF CONTENTS
Welcome ........................................................................................................................................................................ 4 Competency ................................................................................................................................................................... 4 Assessment .................................................................................................................................................................... 4 Essential knowledge:...................................................................................................................................................... 6 Essential skills:................................................................................................................................................................ 7 RANGE STATEMENT ....................................................................................................................................................... 8 EVIDENCE GUIDE ............................................................................................................................................................ 9

APPLY UNDERSTANDING OF THE STRUCTURE AND PROFILE OF THE RESIDENTIAL AGED CARE SECTOR............................................................................. 14
Conduct work that reflects an understanding of the key issues facing older people and their carer/s ...................... 14 Readings of interest ..................................................................................................................................................... 14 What are the most common issues facing aged people? ............................................................................................ 16 Conduct work that reflects an understanding of the current philosophies of service delivery in the sector ............. 21 Recognise the impact of ageing demographics on funding and service delivery models............................................ 22 Conduct work that reflects an understanding of current legislation ........................................................................... 23

APPLY UNDERSTANDING OF THE HOME AND COMMUNITY CARE SECTOR .......... 31


Demonstrate broad knowledge of policy and programs such as HACC, DVA and Government community care directions ..................................................................................................................................................................... 31 Queensland Health Fact Sheet ..................................................................................................................................... 31 Comply with duty of care implementation in home and community settings and worker roles ................................ 35 What is Duty of Care? .................................................................................................................................................. 35 Demonstrate broad knowledge of ageing in place .................................................................................................... 36

DEMONSTRATE COMMITMENTS TO THE PHILOSOPHY OF POSITIVE AGEING .... 37


Take into account personal values and attitudes when planning and implementing work activities ......................... 37 Recognise and manage ageist attitudes through the support of the appropriate person........................................... 38 Recognise the impact of changing expectations of clients, their family and the wider community in relation to service delivery ............................................................................................................................................................ 39 Conduct work that reflects an understanding of the individuality of ageing .............................................................. 39 Conduct work that minimises the effects of stereotypical attitudes and myths on the older person ........................ 40

APPLY UNDERSTANDING OF THE PHYSICAL AND PSYCHOSOCIAL ASPECTS OF AGEING............................................................................................................................. 42


Take into account physical changes associated with ageing when delivering services ............................................... 42 Recognise and accommodate the older persons interests and life activities when delivering services .................... 45 Assist the older person to recognise the impact physical changes associated with ageing may have on their activities of living ......................................................................................................................................................................... 51

APPLY UNDERSTANDING OF CHANGES ASSOCIATED WITH AGEING .................... 53


Take into account physical changes associated with ageing when delivering services ............................................... 53 Apply knowledge of common problems associated with ageing when delivering services ........................................ 61
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Assist the older person to recognise the impact that changes associated with ageing may have on their activities of living ............................................................................................................................................................................. 62 Communicate situations of risk or potential risk associated with ageing to the older person ................................... 63

SUPPORT THE RIGHTS AND INTERESTS OF THE OLDER PERSON ......................... 69


Encourage and support the older person and/or their advocate/s to be aware of their rights and responsibilities .. 69 What services are available to assist aged persons to address their needs and rights? ............................................. 70 Conduct work that demonstrates a commitment to access and equity principles ...................................................... 74 Adopt strategies to empower the older person and/or their advocate/s in regard to their service requirements .... 75 Provide information to the older person and/or their advocate/s to facilitate choice in their decision-making ....... 76 Recognise and report to an appropriate person when an older persons rights are not being upheld ....................... 77 Provide services regardless of diversity of race or cultural, spiritual, or sexual preferences ...................................... 81 Provide information to the older person and/or their advocate/s regarding mechanisms for lodging complaintsManaging Complaints................................................................................................................................. 81 EMPOWERMENT OF THE OLDER PERSON AND/OR THEIR ADVOCATE ........................................................................ 82 Identify indicators of elder abuse and respond appropriately in line with organisation guidelines ........................... 83

SUPPORT THE OLDER PERSON WHO IS EXPERIENCING LOSS AND GRIEF .......... 85
Recognise signs that older person is experiencing grief and report to appropriate person ....................................... 85 Use appropriate communication strategies when older person is expressing their fears and other emotions associated with loss and grief ...................................................................................................................................... 87 Provide older person and/or their support network with information regarding relevant support services as required ....................................................................................................................................................................... 88

DELIVER SERVICES WITHIN A QUALITY FRAMEWORK ............................................. 89


Identify key aspects of the quality framework and how they link together ................................................................ 89 Demonstrate understanding of regulatory/ accreditation quality standards in relation to delivery of services ........ 90 Ensure work practices reflect the organisations policies and procedures ................................................................. 92 Complete documentation that feeds into the quality system ..................................................................................... 94 Participate in quality improvement activities ............................................................................................................ 100

SUSTAINABILITY PRACTICES ..................................................................................... 102


Definition ................................................................................................................................................................... 102 Social .......................................................................................................................................................................... 102 Economic .................................................................................................................................................................... 103 Workforce .................................................................................................................................................................. 103 environmental............................................................................................................................................................ 104

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WELCOME
Welcome to this unit of study. As you work through the learning guide and assessment, you will be developing knowledge about this unit of study. If you do not understand an activity, ask questions and discuss any queries with your trainer, mentor or supervisor. It is important that you develop skills in a work situation, or, in a simulated situation which approximates the workplace as closely as possible. We encourage you to contact us for assistance at any time. Simply call or email and CHARLTON BROWN will be able to assist you.

COMPETENCY
In order to be assessed as competent (C), you will need to provide evidence which demonstrates that you have the essential knowledge and skills to successfully complete the unit to the required standard. Competency is simply being able to demonstrate that you can do the task, not just once, but with confidence, repeatedly. Please read the beginning of this unit, it will tell you about the elements and the performance criteria you will be assessed against. It will also inform you of the knowledge and skills you require to successfully complete the unit. If you can already demonstrate such knowledge and skills you can undertake these skills you should talk to your trainer. Marking guide at the end of each unit you will find a marking guide. This is designed to assist you.

ASSESSMENT
1. 2. 3.

Complete all the assessment tasks in the unit. You will find these at the end of the unit. Have your supervisor sign the statement of validation that you can undertake these skills in the workplace. Complete the Assessment Cover Sheet and sign all sections. Check the marking guide to ensure you have covered all elements of the assessment. The marking guide is used by the assessor to mark off your competency.

The evidence you need to provide for an assessment of competence in this unit will be based on, but not limited to: Successful completion of assessment. Verbal discussion and questioning by assessor. Mentor / supervisor / workplace coach verification of skills. Any other evidence you or your assessor has gathered. Any other activities your assessor considers necessary.

You are required to submit your work in a neat, orderly, detailed and organized manner. Use references in all your work.

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This unit describes the skills and knowledge required by the worker to perform work that reflects understanding of the structure and profile of the residential aged care sector, the home and community sector and key issues facing older people in the community Element Elements define the essential outcomes of a unit of competency. 1. Apply understanding of the structure and profile of the residential aged care sector Performance Criteria The Performance Criteria specify the level of performance required to demonstrate achievement of the Element. Terms in italics are elaborated in the Range Statement. 1.1 1.2 1.3 1.4 2. Apply understanding of the home and community care sector 2.1 Conduct work that reflects an understanding of the key issues facing older people and their carer/s Conduct work that reflects an understanding of the current philosophies of service delivery in the sector Recognise the impact of ageing demographics on funding and service delivery models Conduct work that reflects an understanding of current legislation Demonstrate broad knowledge of policy and programs such as HACC, DVA and Government community care directions Comply with duty of care implementation in home and community settings and worker roles Demonstrate broad knowledge of ageing in place Take into account personal values and attitudes when planning and implementing work activities Recognise and manage ageist attitudes through the support of the appropriate person Recognise the impact of changing expectations of clients, their family and the wider community in relation to service delivery Conduct work that reflects an understanding of the individuality of ageing Conduct work that minimises the effects of stereotypical attitudes and myths on the older person Outline strategies that the older person may adopt to promote healthy lifestyle practices Take into account physical changes associated with ageing when delivering services Recognise and accommodate the older persons interests and life activities when delivering services Assist the older person to recognise the impact physical changes associated with ageing may have on their activities of living Take into account physical changes associated with ageing when delivering services Apply knowledge of common problems associated with ageing when delivering services Assist the older person to recognise the impact that changes associated with ageing may have on their activities of living Communicate situations of risk or potential risk associated with ageing to the older person

2.2 2.3 3. Demonstrate commitment to the philosophy of positive ageing 3.1 3.2 3.3

3.4 3.5 4. Apply understanding of the physical and psychosocial aspects of ageing 4.1 4.2 4.3 4.4

5.

Apply understanding of changes associated with ageing

5.1 5.2 5.3

5.4

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Element Elements define the essential outcomes of a unit of competency. 6. Support the rights and interests of the older person

Performance Criteria The Performance Criteria specify the level of performance required to demonstrate achievement of the Element. Terms in italics are elaborated in the Range Statement. 6.1 Encourage and support the older person and/or their advocate/s to be aware of their rights and responsibilities Conduct work that demonstrates a commitment to access and equity principles Adopt strategies to empower the older person and/or their advocate/s in regard to their service requirements Provide information to the older person and/or their advocate/s to facilitate choice in their decision-making Recognise and report to an appropriate person when an older persons rights are not being upheld Provide services regardless of diversity of race or cultural, spiritual, or sexual preferences Provide information to the older person and/or their advocate/s regarding mechanisms for lodging complaints Identify indicators of elder abuse and respond appropriately in line with organisation guidelines Recognise signs that older person is experiencing grief and report to appropriate person Use appropriate communication strategies when older person is expressing their fears and other emotions associated with loss and grief Provide older person and/or their support network with information regarding relevant support services as required Identify key aspects of the quality framework and how they link together Demonstrate understanding of regulatory/ accreditation quality standards in relation to delivery of services Ensure work practices reflect the organisations policies and procedures Complete documentation that feeds into the quality system Participate in quality improvement activities

6.2 6.3 6.4 6.5 6.6 6.7

6.8 7. Support the older person who is experiencing loss and grief 7.1 7.2

7.3

8.

Deliver services within a quality framework

8.1 8.2 8.3 8.4 8.5

ESSENTIAL KNOWLEDGE:
The candidate must be able to demonstrate essential knowledge required to effectively perform task skills; task management skills; contingency management skills and job/role environment skills as outlined in elements and performance criteria of this unit These include knowledge of: Own work role and responsibilities Principles of access, equity and client rights when working in the aged care sector Structure and profile of the aged care sector Relevant policies, protocols of the organisation re unit content and work role Legislation, regulations and policies relevant to work in the aged care sector, including: - settings such as residential and home and community care - issues such as elder abuse, drug administration and access and equity Understanding of basic quality management principles such as: people, paper and proce sses, Plan Do Check Act cycle
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Overview of applicable accreditation or quality standards required by an external regulatory, accreditation or funding body Knowledge of quality monitoring activities such as audits, collection of data, visits by external bodies Contemporary issues facing older people in the community Current service delivery models Philosophy of various service delivery models Factors influencing service delivery models in the sector Ageing demographics Understanding of the ageing process and related physiological/psychological changes Foundation knowledge of common physiological, chronic and age-related conditions such as: - arthritis and other musculoskeletal problems - depression - diabetes - frailty and deconditioning - heart and lung disease - incontinence - neurological disorders - skin disorders including skin cancers - stroke - vascular disease Understanding attitude, stereotypes and false beliefs associated with ageing Impact of personal values and attitudes on service delivery Rights and responsibilities of older people and those working in the aged care sector Physical and psychosocial aspects of ageing in supporting older people to maintain their quality of life Impact of normal ageing on the older person Stages of loss and grief and impact of ageing on persons experiences of loss and grief Overview of the manifestations and presentation of common problems associated with ageing Relevant care needs and strategies related to common problems associated with ageing Role of carers Principles of empowerment and disempowerment The social model of disability The impact of social devaluation on an individuals quality of life Competency and image enhancement as a means of addressing devaluation Principles and practices of confidentiality and privacy Strategies for supporting an older person and/or their advocate/s to exercise their rights Strategies for managing complaints Basic knowledge and application of quality principles and accreditation standards in aged care and home and community care

ESSENTIAL SKILLS:
It is critical that the candidate demonstrate the ability to: Follow organisation policies and protocols Liaise and report to appropriate person/s Adhere to own work role and responsibilities Apply the principles of access, equity and client rights when working in the aged care sector Adopt a non-ageist and accepting attitude when working with older people Make informed observations and report appropriately in line with work role Recognise signs of deteriorating health and function and refer to supervisor and appropriate health professional

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Record information and complete documentation accurately and in an timely manner Identify and respond to opportunities for improvement within the organisations quality system

In addition, the candidate must be able to demonstrate relevant task skills; task management skills; contingency management skills and job/role environment skills These include the ability to: Apply knowledge of physical and psychosocial aspects of ageing in supporting older people Apply reading and writing skills required to fulfil work role in a safe manner and as specified by the organisation/service This requires a level of skill that enables the worker to follow work-related instructions and directions and the ability to seek clarification and comments from supervisors, clients and colleagues Industry work roles will require workers to possess a literacy level that will enable them to interpret international safety signs, read clients service delivery plans, make notations in client records and complete workplace forms and records Apply oral communication skills required to fulfil work role in a safe manner and as specified by the organisation This requires a level of skill that enables the worker to follow work-related instructions and directions and the ability to seek clarification and comments from supervisors, clients and colleagues Industry work roles will require workers to possess oral communication skills that will enable them to ask questions, clarify understanding, recognise and interpret non-verbal cues, provide information and express encouragement Apply numeracy skills required to fulfil work role in a safe manner and as specified by the organisation Industry work roles will require workers to be able to perform basic mathematical functions, such as addition and subtraction up to three digit numbers and multiplication and division of single and doubledigit numbers Apply basic problem solving skills to resolve problems within organisation protocols Work effectively with clients, colleagues, supervisors and other services/agencies

RANGE STATEMENT
The Range Statement relates to the unit of competency as a whole. It allows for different work environments and situations that may affect performance. Add any essential operating conditions that may be present with training and assessment depending on the work situation, needs of the candidate, accessibility of the item, and local industry and regional contexts Older people may include: Individuals living in residential aged care environments Individuals living in the community Prospective individuals to the service or services Contexts may include: Older persons own dwelling Independent living accommodation Residential aged care facilities Community centres Community/government agencies Issues facing older people may include: Changes that ageing may bring to: - physical processes - cognitive function (including dementia) - social interaction - role and family relationships - living arrangements - level of independence (financial, community access, self care) Loss and grief Family carer issues

Societal attitudes and expectations Current philosophies of service delivery may include:

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Changing societal expectations (consumerism) Changing political context (polices and initiatives) Changing economic context Impact of ageing demographics 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

Rights are detailed in: Legislation - Residential Care Manual - Aged Care Act Industry and organisation service standards Industry and organisation codes of practice and ethics Accreditation standards International and national charters Organisation policy and procedure Access and equity principles may include: Creation of a client orientated culture Non-discriminatory approach to all individuals using or accessing the service Respect for individual differences

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

Report may be: Verbal: - telephone - face-to-face Non-verbal (written): - progress reports

case notes incident reports

EVIDENCE GUIDE
The evidence guide provides advice on assessment and must be read in conjunction with the Performance Criteria, Required Skills and Knowledge, the Range Statement and the Assessment Guidelines for this Training Package Critical aspects for assessment and evidence required to demonstrate this unit of competency: The individual being assessed must provide evidence of specified essential knowledge as well as skills

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This unit will be most appropriately assessed in the workplace or in a simulated workplace and under the normal range of workplace conditions It is recommended that assessment or information for assessment will be conducted or gathered over a period of time and cover the normal range of workplace situations and settings Where, for reasons of safety, space, or access to equipment and resources, assessment takes place away from the workplace, the assessment environment should represent workplace conditions as closely as possible

Access and equity considerations: All workers in community services should be aware of access, equity and human rights issues in relation to their own area of work All workers should develop their ability to work in a culturally diverse environment In recognition of particular issues facing Aboriginal and Torres Strait Islander communities, workers should be aware of cultural, historical and current issues impacting on Aboriginal and Torres Strait Islander people Assessors and trainers must take into account relevant access and equity issues, in particular relating to factors impacting on Aboriginal and/or Torres Strait Islander clients and communities

Context of and specific resources for assessment: This unit can be assessed independently, however holistic assessment practice with other community services units of competency is encouraged Resources required for assessment include: - access to appropriate workplace where assessment can take place - simulation of realistic workplace setting for assessment relevant organisation policy, protocols and procedures

Method of assessment Observation in the workplace Written assignments/projects Case study and scenario analysis Questioning Role play simulation

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Term Accreditation

Meaning Means measuring a services performance against Australian Accreditation Standards set for the service type. If the service meets or exceeds the standards they receive accreditation. Is a type of brain damage that occurs after birth trauma, stroke, an infection, disease or disorder. Adaptive equipment assists people with disabilities to participate in daily activities. Has physical activities and exercise designed for people who find it difficult to move. Helps a person to make decisions about their care. Advocate can attend discussions about a persons support and care. They make sure the person receives the service they want and need. Means thinking all older people are the same. It also means making decisions about older people based just on their age. A government policy enabling a person to live in their own home as long as possible, bringing the services to the person, rather than moving the person to where the services are. Means having poor motivation or energy and not caring. Irregularities, abnormalities or differences. A. Lacking interest in or desire for sex B. No evident sex organs The persons ability to make choices about their lives governed by individual principles. Notes document cares carried out for the client. Notes may record information about a resident/ clients health. A care plan describes the care needs of a resident/ client. It explains what care is needed and how and when the care should be provided. A case conference is a formal meeting where stakeholders, including the resident/ client, discuss ways to achieve the residents/ clients goals and develop an action plan. This approach means the focus is placed on the persons individual care. Means present at birth. Is how complaints are reported, managed and addressed. Means giving permission for something, or saying that you agree for something to happen. Means having control over bladder and bowel. A professional person trained to help other people with their problems. Means serious weakening of energy. A condition caused by limited intake of water (fluids). The term used to describe a range of conditions that cause progressive loss of memory and thinking skills. . A medical condition where a person feels sad or tired all the time and not interested in life. They are not able to make themselves feel better and often need medical help. A medical condition where the body is not able to process sugars properly. A qualified health professional that specialises in the study of food and its nutritional properties. They give advice on the design of special diets. The quality of being worthy of respect.

Acquired brain injury (ABI) Adaptive equipment Adaptive program Advocate exercise

Ageism Ageing in place

Apathy Anomalies Asexual Autonomy Progress note Care plan Case conference Person-centred Congenital Complaints resolution system Consent Continence Counsellor Debilitating Dehydration Dementia Depression Diabetes Dietician Dignity

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Term Discrimination Disengaged Dosette box Duty of care

Meaning Unfair treatment of a person, racial group, minority, etc. To be disengaged is to be isolated, disconnected or social emotionally removed from the community or other people. Organises a persons pills so they know how many to take and when to take them . The term used to describe the obligations employers and employees have to each other and those they are caring for. It includes making sure you provide appropriate care to meet the persons needs, treat them with respect and maintain a persons rights to privacy. A careful system of managing financial resources. Is when an older person is deliberately mistreated and is not receiving appropriate care The ability to perceive and feel directly the emotions of another. Risk that is identified within surrounding area Using ones mind. Inability to maintain normal bowel movement. Involves precise controlled movement of the hands and fingers. A service usually delivered by volunteers, who go to the homes of elderly or disabled people in order to visit them on a social basis, to chat and provide companionship. An aspect of person identity, it is ones view of oneself as a male or female irrespective of biology. Food prepared and presented according to Islamic law. Is a document that records information about risks and hazards. Relationship between a male and female. Gay relationship refers to there are two males in a relationship; Lesbian relationship refers to two females in the relationship. Means knowing what choices they have. Means being given information to understand all the choices. It means being allowed to make the choice. The process of admitting a client into care and assessing their needs. Information has integrity when it is accurate, current and reliable. Is a plan strategy, including taking steps to address problems, conditions or complaints. Is food prepared and presented according to Jewish law. Refers to the legal requirement to report suspected or actual abuse of a client. Is a government-funded service that delivers meals to elder or disabled people who live at home if they are unable to cook their own meal. Is all the physical and chemical process occurring in the body that allow life and normal functioning. Means the ability to move around. Something that affects the nervous system. Is the best possible physical, psychosocial, and spiritual wellbeing a client is capable of achieving. Can be bought in a chemist or supermarket. They do not need a prescription from a doctor. The amount of pain a person need to feel before the sensation of pain is experienced. The care of a person who is dying. It means caring and offering comfort and dignity to
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Economy Elder abuse Empathy Environmental hazard Exercising mentally Faecal incontinence Fine motor tasks Friendly visiting Gender identify Halal Hazard report Heterosexual Homosexual Informed choice Intake / Admission Integrity Intervention Kosher Mandatory reporting Meals on wheels Metabolic Mobile Neurological Optimal health Over the counter medication Pain threshold Palliative care
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Term Parkinsons disease Pathogens Physiotherapist Population Post traumatic stress disorder Privacy

Meaning the client when medical care cannot make them better. Neurological condition that affects the control of the body movements. Are agents that cause disease such as bacteria, fungi, viruses and parasites A health professional who uses exercise and physical activities to help condition muscles and improve level of activity. Means the number of people living in a country or area. PTSD is a severe and ongoing emotional reaction to traumatic events that have threatened or caused grave physical harm. The quality or condition of being secluded from the presence or view of others; Privacy means respecting the right of the older person to have their care provided with privacy and dignity. Are a set of rules and behaviour workers are to follow in an organization. Behaviour and mental state. Involving aspects of social and psychological behaviour Respite care means care provided away from home and offers carers a break and clients a change of environment. Having finished ones paid active working life. Are legal or moral entitlements that a society creates which determine what is right, allowed or not allowed Self care or allows a person the opportunity to perform care independently. Means a person hurts themselves, emotionally or physically. Means how you feel about yourself and your own value as a person. Something that causes a sudden or violent disturbance in emotions Is a person other than family who is involved with client. Is an indication of illness or disease that is visible or measurable. Is a belief or idea about a person or a group of people. Is a medical condition where part of the brain is affected by a blockage of the blood vessels or a burst vessel causing bleeding into the brain. Is the group of people who are able to support the older person in times of need. A sign of an illness or disease that is not measurable or readily observable; it may be how the person feels. A way of connecting groups of people via a group telephone call. It works like a conference call but it is used to connect isolated people who have a common interest or need. Is the first point of assessment at the hospital. Means difficulty in, or inability to maintain normal bladder control. Describe the beliefs and morals of an individual, culture or organisation.

Protocols Psychological Psychosocial Respite Retired Rights Self care Self destructive behaviour Self- esteem Shock Significant other Sign Stereotype Stroke/ Cerebrovascular Accident (CVA) Support network Symptom Telelink

Triage Urinary incontinence Values

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APPLY UNDERSTANDING OF THE STRUCTURE AND PROFILE OF THE RESIDENTIAL AGED CARE SECTOR ..............................................................................................
CONDUCT WORK THAT REFLECTS AN UNDERSTANDING OF THE KEY ISSUES FACING OLDER PEOPLE AND THEIR CARER/S
What is old age? When does it start? When you think about these two questions what you may have thought was straight forward can become rather complex and the answers are not always straightforward. The Oxford Dictionary defines age as a naturally distinct period or stage of life; to grow or make old There are several definitions of the word old. Depending on which dictionary you look at, you may find terms like wise, familiar, and having much experience, along with the more readily accepted worn out by age or far advanced in years. In answering t hese questions we have assumed that old age is measured in years, but there are many senior citizens who, although far advanced in years, are most definitely not worn out by age.

READINGS OF INTEREST
Reading #1

The Aged Individual OBJECTIVES


1. 2. 3. 4. 5. Discuss the changes and effects associated with physiological ageing. State the stresses associated with ageing. Describe the measures which can be implemented to promote independent function in the elderly. State the facilities which are available to support the elderly in the community. Assist in planning and implementing care of the elderly person in hospital.

6. Assist in the planning and implementing care of a confused elderly person.

Introduction
The number of people over 65 years of age is increasing every day. Individuals are living longer and are healthier than ever before so that today, the majority of people can expect to live into their seventies. It is estimated that by the end of this century there will be a considerable increase in the number of people over 80 years of age with consequences for the whole of society. Ageing is a normal process which is accompanied by changes in body structure and function. Because of the changes the elderly have special needs and are at greater risk of illness, chronic disease and injuries.

Gerontology is the study of the normal process of ageing; while geriatrics is the branch of medical
science dealing with the treatment of disease in elderly. Research is continuing in an effort to discover more about how the body ages and new theories of ageing are continually being developed. A recent suggestion is that cell structures called mitochondria may be involved in the ageing process. Research has suggested that mitochondria appear to decrease in number, and become more easily damaged in older people. All of the enzymes which break down nutrient substances into carbon dioxide and water, together with the enzymes which enable the transfer of released energy to stable high-energy compounds, are present within the mitochondrial structure therefore; it is considered that there is less efficient mitochondrial activity in elderly people. It is now evident that ageing is a complicated and variable process subject to modification from environmental, chemical and physical forces and influenced by genetic factors and disease. The effects of physical and psychological ageing may be quite varied within a group of people of the same chronological age. It is also clear that there is no universally accepted theory of ageing, however it is important for nurses to understand that ageing is a normal process. It is also important that nurses (and others who work with elderly people), understand that pathological changes due to disease should not be confused with normal

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ageing. To help determine the difference between the natural results of ageing and the warning signals of disease, the nurse should understand that with old age: Not all functional changes are related to disease; many are the results of ageing and can be compensated for. Sensory receptors and compensatory mechanisms gradually decline so the body does not respond as vigorously to injury or disease. Health problems frequently occur in clusters. There is increasing vulnerability to disease. This is because the body gradually loses its reserve capacity, its resistance to stress, and its ability to adapt.

Stresses associated with ageing


Ageing, like the other stages of development, is associated with stress. Stress can be produced by any factors that require a response or change in the individual. Stressors can be physical, psychological, chemical, developmental or emotional. While some stresses may be positive others can be negative.
Reference: Tabbners Nursing care theory and practice Page 609.

Stresses of Ageing
The changes brought about by the process of ageing are numerous and, as we have discovered, may not affect every ageing individual in exactly the same manner. Remember that every person is an individual with various experiences and cultural understandings. Before we look at the physical effects of ageing it is worth firstly considering the stresses associated with ageing as these can sometimes be more damaging to the individual than the physical changes. Tabbners Nursing Care: Theory and Practice lists the following as stresses associated with ageing: Fear of ageing - Many people fear the decline in physical and / or mental function that may accompany ageing.

Fear of isolation - Depression, frustration or anger may result from inability to function as previously. Loss - Many losses accompany ageing e.g. loss of income, mobility, health, strength, hearing and or sight, partner and or
friends.

Physical deterioration - Depression, frustration or anger may result from inability to function as previously. Impaired cognitive function - Even minor lapses in memory and judgment may cause an elderly person to become very Change of environment - Adjustment to old age is made easier when personal possessions and a familiar setting surround

anxious that they are loosing their mind. Confusion itself is a very common reaction to stress so this can be a case of the dog chasing its tail! the individual. Facing the prospect of having to move to another setting e.g. due to illness or inability to cope, is one of the most common fears experienced by many elderly people. Reading #2 From: How do Aged Care Workers compare with other Australian workers? By National Institute of Labour Studies Employment Status Another major aspect of the types of jobs available to workers in aged care is the form of employment relationship. In the Australian workforce generally, more than one quarter of employees are in casual jobs. In general, they receive fewer of the benefits that accompany permanent or continuing employment. The absence of paid sick and annual leave is taken (by the ABS) to be the identifier of casual employment. While many casual workers are compensated by a loading on their hourly rate of pay, others are not. And there is controversy over whether they have lower job satisfaction (Wooden & Warren, 2004). In aged care, casual employment is comparatively uncommon. Approximately 12 per cent of female aged carers have casual work arrangements, whereas nearly one third (31%) of all female employees do. The vast majority (82%) of female carers are in continuing jobs. This is a remarkable rate of permanency when compared with all female employment (of which 59% is continuing). Fixed-term contract employment is also less common in aged care. Our survey data may slightly

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underestimate the true incidence of non-continuing employment amongst direct care workers in aged care facilities, primarily because it does not cover agency staff not employed by the facility. However, previous research estimated that their inclusion would not significantly alter the picture since only 2.5 to 3.5 per cent of all shifts are worked by such staff (Richardson and Martin 2004: 48). The findings stated that persistently higher rates of job permanency in aged care and hence lower rates of casualisation than is typical for employed women with similar experience in their current jobs. Among carers, those who have been employed at their particular facility for a short time (i.e., less than one year), are substantially more likely to be engaged on a casual basis (36%). But they are less likely to be in this position than other females with a similar amount of experience in their (non-aged care) jobs (50%). At all levels of experience, the aged care industry offers greater job permanency to women workers than does the labour force at large. Our survey asked aged care workers how many hours they would prefer to work per week. We grouped the workers responses to this question into three categories depending on whether they preferred to have more paid hours each week, fewer paid hours, or no change in their existing arrangement. We have already reported the fact that around one quarter of all carers prefer more hours, while 14 per cent prefer fewer (Richardson & Martin, 2004: pp.22-24). The results confirm that carers who want an increase in their weekly hours are more likely to be in casual jobs: 18 per cent of those wanting an increase in hours are casuals, compared to 5 per cent of those who want a decrease, and 11 per cent of those who prefer no change. We can see the same pattern in the data for all employed women. However, the finding for aged care workers must be set against the generally low incidence of casualisation in their industry. The association between employment status and hours preference is much more pronounced outside of aged care than inside.

Earnings
In our original discussion of the aged care workforce survey data, we showed that three quarters of nurses in the industry earn above a threshold level of weekly employment income ($500 per week), while large proportions of the personal care attendant and allied health workforces (at least 60% in each) earn below it. The limitation of weekly earnings data is that they do not account for the fact that many jobs are part-time, including in the aged care industry, as we have seen above. To better evaluate the issue of pay, we need to focus on hourly earnings. The calculations can be made by dividing workers assumed weekly earnings (their wages over a typical pay period, converted to a weekly basis) by their usual weekly work hours. Once this conversion was made, we grouped carers into five hourly earnings bands. We did this by ordering the distribution of individual workers hourly earnings from highest to lowest and dividing into five nearly equal groups or quintiles.

WHAT ARE THE MOST COMMON ISSUES FACING AGED PEOPLE?


Even before birth we, as humans, are diverse individuals with differing physical needs and abilities and differing psychological needs and abilities. Changes are brought about by many factors including environment, genetic disposition, chronic or debilitating illness, and, for the most, the ageing process. Issues faced by the older person:

Changes and/ or changing Cognitive Family Attitudes in society Cognitive Changes


Many older persons find that their thought processes may be slower or find it may be harder to remember things such as the names of people or places. Forgetting where the house keys were last placed or even what happened yesterday. These changes can be related to dementia, which is symptomatic and progressive loss of memory and thinking skills. However, not all cognitive changes are related to this disease but simply a process of ageing. As an aged care worker, you can help the older person manage cognitive changes by helping or encouraging them to: Use a calendar to put appointments on.
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Physical Living Loss and grief

Social Independence Family carers

Write reminder notes. Talk about important details and events. Write down phone numbers and names. Participate in activities. Being aware of things that upset residents/ clients is important as this is part of your responsibility to observe/ watch for changes in the older persons ability to think. This information needs to be recorded and your supervisor advised of any changes.

Examples of issues that need to be reported to your supervisor: You are worried about the persons cognitive ability. You have noticed a major change in their cognitive ability. You think the older person is not safe.

Physical changes

Physical changes happen as we age. These will vary from one individual to another. Muscles may not be as strong. Flexibility can reduce, as can mobility. Hearing and sight can become affected requiring glasses and even a hearing aid. Skin becomes thinner and may break and tear easily.

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As an aged care worker you can help the older person manage these changes by: Encouragement of exercise. Being watchful of hazards that could cause the older person to trip or fall. Assisting the older person to move from place to place safely.

Ensuring that aids work walking stick is in good working order.


Assisting the older person to look after their glasses. Observes how the older person moves and note any changes. Be aware of changes, record and report them to your supervisor.

Social changes
It can become more challenging to maintain social interactions for the older person. Many factors can influence this. The ability to go out once the car license has been revoked by not being able to pass the medical test to renew the license. Being able to stay in touch with people can also become harder. As an aged care worker you can help the older person manage these changes by: Encourage phone calls to family and friends. Assisting the older person to source social groups or activities. Drive the person to activities. Assist the person to write letters or emails. Talk about photos. Respect privacy. Some people can become quite sad and lonely when things change in their social life. Old friends may die or family members move away. Just because a person is sad or lonely does not mean they are depressed. Depression must be assessed by a doctor or psychologist. Examples of issues that could require further investigation to determine if a person is suffering depression need to be reported to your supervisor: A person is sleeping excessively. Behavioural changes. Not being very responsive. Aged care workers cannot diagnose or treat depression. Any changes in a resident/ client of concern must be reported to your supervisor.

Family Changes
Family dynamics are constantly changing. Children grow up and have their own children. They move away. In todays society busy lifestyles often make it harder to look after ageing parents. Not everyone is able to look after an ageing person especially when its a family member that requires the care. They may not have the skills they need. As needs change the older person may require additional care such as respite care which gives the unpaid carer a rest by providing care for a short time. Services like this enable the older person to remain at home longer.

Changes in living arrangement


A house is more than a place to live. A home has family memories, a link to neighbours and the community. It is also brings pride and self-esteem. Ageing can lead to changes in housing. Due to a diverse range of factors the older person may need to move house. There is a number of living arrangements that the older person can now choose from: Retirement village. Apartments. Assisted living. Living with family.
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Hostel care. Ageing in place. Residential care. Having to move can be very stressful to the person and takes time to adjust to the changes. As an aged care worker, you can help the older person manage these changes by: Talking to the older person about how they feel. Listening when the older person wants to talk. Showing where things are kept. Helping them find their way around. Treating them with respect and remembering it is the persons home. Giving choices. Be observant of changes and reporting to the supervisor.

Independence changes
Most people like to do things for themselves. Being able to maintain independence enables a person to feel in control of their own lives. At times, being able to maintain their independence can be difficult for any number of reasons. The older person could require help with such things as their finances, care and mobility. As an aged care worker you can help the older person with: Financial matters by: o o o o o o o Being honest. Assist with paying bills. Assist with shopping. Writing down what has been spent. Ensuring the older persons money is safe. Ensure that you document what you have done with the person s money. Report to your supervisor and seek clarification if you are unsure of what to do regarding money matters.

Transport getting around can be difficult. Identify the older persons needs. Once this has been done then you may need to:
o o o o Plan the trip how are you going to get there and how long will it take. Arrange transportation for the person. Assist the person in and out of the car. Drive the older person.

Personal care tasks this may present challenges as most people like to do things for themselves. Always make sure you:
o o o o o o o o Ask consent before doing anything. Ask what assistance is needed. Ask how they would like things done. Ensure privacy is maintained. Remember people are individuals. Be respectful and polite. Check that the person is safe. Advise your supervisor of any issues.

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Case study
Mrs. June Wattle lives in a unit. You help her once a week to do her shopping. June has arthritis which affects her hands limited movement of her fingers. She also has trouble with remembering things. June will now be receiving assisted hygiene care three times a week. 1. What workplace policy or procedures would follow when handling Junes money: a. b. 2. What should you do when handling money helping June do her shopping? What sort of things would you need to write down?

You will need to know how June likes her personal care done. So by taking notes and asking questions you will be able to gather information about: a. b. c. d. Having hair washed. Having teeth cleaned. Having a shower. Getting dressed.

Be prepared to discuss with your supervisor or trainer.

Attitudes in society
Older people in the community are believed to be good. Other people think that older people should stop work as soon as they turn 65 years old. That they should go into nursing homes. There are many perceptions of the older person with some of these not always being positive. As an aged care worker, you should: Explain to family members and others the value of the older person participating in activities. Support the older person to travel to activities and social centres. Encourage contributions and to continue in activities that interest them.

Loss and grief


Grief, loss, death and dying are all part of the life cycle. Everyone experiences these at different times during their life. It is no different for the older person. Losing a loved one or the ability to do things that once one could do make people feel sad. Many are uncomfortable with their feelings about loss and grief. Grief is a natural response to loss. Responses can be complex and varied. Loss is an actual or potential situation in which something or someone that is valued is no longer seen, felt, or experienced. It can be temporary or permanent, complete or partial, physical or symbolic. Grief is the emotional response to the loss and the changes that have resulted because of that loss. As an aged care worker, you should: Listen to the older person. Do not make the older person feel bad about their feelings. Assist the older person to be positive. Encourage talk about friends and family who are still around.

Family carers
Many families are close and you will work with residents/ clients who have family members wanting to be informed and involved in their care. There are also those who are not close to family members or they simply dont get along. Some families may become upset if something happens to their older relative or if their relative is unable to do things they once could do. They may struggle with trying to understand what is happening or the need for care. Often they will want to keep their loved one at home yet may find this very difficult. Families can face many challenges and often this is reflected in their emotional reactions. As carers you will need to adhere to the privacy and confidentiality of your resident/ client and this can also create issues when family members want information you are unable to provide due to these policies and codes.

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As an aged care worker, you can help families by: Remembering all families are different. Using communication books to share ideas with the family. Listening to what family members want to talk about. Explaining changes simply and clearly. Not sharing private information. Ensuring family members get a real rest and time away when providing respite care.

CONDUCT WORK THAT REFLECTS AN UNDERSTANDING OF THE CURRENT PHILOSOPHIES OF SERVICE DELIVERY IN THE SECTOR
Aged care is provided regardless of if it is in a facility or in the home. Both aged care facilities and the community are funded by the government. Having an understanding of age care services is of importance to know what it means for the work you do. Things that you need to be aware of: Government policy on residential aged care services. Ageing in place is an Australian government concept where by the older person remains in their home for as long as possible. The older person may become too frail or unable to make decisions for themselves, even a risk to their safety often will then require the older person to move into a residential facility. Ageing in place also applies to residential facilities. It is about helping the older people remain in their aged care facilities, and not move them just because their care needs change. There are high quality standards that all residential aged care facilities need to meet. These standards are set by the government and outlined in the Residential care manual. Accreditation is recognition of meeting these standards. Should an aged care facility not meet the standard, they are given a set time to make the required amendments. Once again if this is not met then the facility is shut down. This ensures that all services provide a high quality of care.

As an aged care worker, you can help the older person adjust to the lifestyle in an aged care facility by: Providing a high quality of care, including: o o o A warm / cool room. Having clean cloths. A clean showering area.

Following policies and procedures of the organisation to ensure safety. Ensuring that everyone is comfortable and given support. Checking that they have food they like. Ensure that their room is as home like as possible. Providing as much information about the ranges of activities available. Ensure they are given choices.

Clients expectations of residential aged care services are to be provided with: A good service. Fair treatment and with respect. Ability to follow own interests. Food they like. Treatment as an individual. The economy affects residential aged care services in that a strong economy can afford to pay for all the services needed by the people living there. In Australia, the economy relies on having people working and paying taxes. If the government cannot collect enough money from taxes it may not then be able to pay for all the services it wants to.

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According to a report by the National Institute of Labour Studies, Who cares for older Australians? , the total of those employed in aged care homes rose from about 157,000 to about 175,000 between 2003 and 2007. According to the Australian Bureau of Statistics (ABS) Australia had a population of 22 million in 2008

RECOGNISE THE IMPACT OF AGEING DEMOGRAPHICS ON FUNDING AND SERVICE DELIVERY MODELS
Australia has an aging population. What this means is that there is an increasing number of people of the age of 65 years and over. The projected growth is from 2.5 million in 2002 to 6.2 million in 2042. There are a number of factors that have led to an increase in the dependency burden or dependency ratio. This is a term used to describe the numbers of aged population compared with the numbers of working age population. The growing number of aging population in size will particularly place stress on the provision of health and welfare services in the near future. There is an urgent necessity for forward planning in aged care for the changing demographic situation. Aged care has become a significant part of the economy; it is clear that ageing and aged care has become almost a national economic obsession. This is because the governments and media are now alert to the potential economic impact for Australia as a result of the ageing Baby Boomer. A quote from a 2004 Financial Review article serves to illustrate this concern: The effect of longevity on a world that is already short of children. is scary reading (it shows) a generational debt of $US45 trillion in America that someones kids are going to have to payThe social implications of an ageing population are mind boggling. Imagine: walking frames will outnumber strollers, incontinence pads will outsell nappies [Macken,2004,p.28] Care organisations receive funding from the Commonwealth and state governments based on the level of care required by individual clients. Each clients needs are assessed; a rating given; and a claim for funding made against this assessment. The funding so granted to organisations is audited. The care organisations validate their funding claims by means of the care documentation. Completing documentation is critical for the successful operations of the organisation. A new system of funding was introduced from 20 March 2008 called the Aged Care Funding Instrument replacing the Residential Classification Scale (or RCS) (www.health.gov.au/acfi) this system will assess new residents going into residential care, with existing residents being assessed using the ACFI when their classification under the current RCS subsidy expires. This new system will reduce the hours spent assessing residents for funding. The following are the funding categories: The areas or domains, of funding are: 1. Activities of Daily Living. 2. Behaviour Supplement. 3. Complex Health Care Supplement. Each of these domains has three funded levels - Low, Medium and High.

How does the ACFI work?


The ACFI uses information from 12 questions and 2 categories of diagnosis to place a resident in the Low, Medium, or High category of each of the three funding domains. No funding will be provided for a domain if the resident has no or minimal assessed care needs.

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The relationship between the questions and the funding domains is shown in the illustration below.
The Funding Instrument ADLs 1. Nutrition 2. Mobility 3. Personal Hygiene 4. Toileting 5. Continence Each questions A, B, C, or D has a SCORE The total score determines the LEVEL Each questions A, B, C, or D has a SCORE The total score determines the LEVEL Complex Health Care 11. Medication 12. Complex Health Care A, B, C, or D applied to a MATRIX determines the LEVEL Diagnoses Mental & Behavioural Medical Low Medium High Medium Low Low Medium Score The Funding Model High

Behaviour

6. Cognitive Skills 7. Wandering 8. Verbal Behaviour 9. Physical Behaviour 10. Depression

High

Used for minimum data set, support of other ratings, and Behaviour Supplement

Further information on the ACFI is contained in the other information sheets and available from the Department of Health and Ageings web site: www.health.gov.au/acfi

CONDUCT WORK LEGISLATION

THAT

REFLECTS

AN

UNDERSTANDING

OF

CURRENT

As well as the many laws that provide societys framework of right and wrong, there are many laws and regulations which are specifically designed to ensure that those working within the aged care industry are doing so in a safe and ethical way. The rules and laws for residential aged care include:

Aged Care Act 1997 (Cth) = (commonwealth) - applies to all services including aged care facilities,
community care services, transitional and respite programs. This act provides the guidelines of how care is given and ensures a quality of services are provided to the older person. Standards for Aged Care Facilities Standard 1: Management Systems, Staffing and Organizational Development Management Systems, Staffing and Organisational Development Principle: Within the philosophy and level of care offered in the residential care service, management system, are responsive to the need of residents, their representatives, staff and stakeholders and the changing environment which the service operates. Standard 1.1 Standard 1.2 Standard 1.3 Standard 1.4 Standard 1.5 Standard 1.6 Standard 1.7 Continuous improvement Regulatory compliance Education and staff development Comments and complaints Planning and leadership Human resource management Inventory and Equipment

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Standard 1.8 Standard 1.9

Information systems External services

Standard 2: Health and Personal care Health and personal care Principle: Residents physical and mental health will be promoted and achieved at the optimum level in partnership between each resident (or his or her representative) and the health care team. Standard 2.1 Standard 2.2 Standard 2.3 Standard 2.4 Standard 2.5 Standard 2.6 Standard 2.7 Standard 2.8 Standard 2.9 Continuous improvement Regulatory improvement Education and staff development Comments and complaints Planning and leadership Human resource management Inventory and Equipment Information systems External services

Standard 3: Resident lifestyle Resident lifestyle Principle: Residents retain their personal, civic, legal and consumer rights, and are assisted to achieve active control of their own lives within the residential care service and in the community. Standard 3.1 Standard 3.2 Standard 3.3 Standard 3.4 Standard 3.5 Standard 3.6 Standard 3.7 Standard 3.8 Standard 3.9 Standard 3.10 Continuous improvement Regulatory improvement Education and staff development Emotional support Independence Privacy and dignity Leisure interests and activities Cultural and spiritual life Choice and decision making Residents security of tenure and responsibilities

Standard 4: Physical Environment and Safe Systems Physical environment and safe systems Principal: Residents live in a safe and comfortable environment that ensures the quality of life and welfare of residents, staff and visitors. Standard 4.1 Standard 4.2 Standard 4.3 Standard 4.4 Standard 4.5 Standard 4.6 Standard 4.7 Standard 4.8 Continuous improvement Regulatory improvement Education and staff development Living environment Occupational health and safety Fire, security and other emergencies Infection control Catering, cleaning and laundry services

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An understanding of the standards by which residential care facilities are held accountable is valuable information. It is these standards which dictate the standard of care delivered and the quality of the working environment. Compliance with these standards also ensures ongoing training and in-service education for the staff, along with currency of skill and knowledge base. Implementation of standards in aged care has brought with it consistency of care and accountability for providers - both of which only serve to enhance the standard of care and elevate the status of the industry. Other guidelines from the Aged Care Act: Ensuring everyone has equal access to care. Ensuring care is not refused due to someones: o Racial background or language. o Finances. o Background or lifestyle. Describing what the aged care service needs to do. Giving respite to carers. Making sure that there is a range of services to suit all needs. Helping older people enjoy the same rights as others.

Helping people age where they want to (ageing in place). The Aged Care Act is a legal document. To ensure you are complying with the requirements of this act, you need to do what you supervisor tells you and follow your workplace policies and procedures.

Access and Equity


Access and equity principles support the view of equal rights, specifically the right to access and, the right to have an equal share of whatever is on offer. Minority groups should not be disadvantaged in this respect. Access and equity principles are applied broadly across many societal sectors, one example being the Government and the issuing of funds to states and territories. Older people living in care facilities or receiving aged care services have the right to access all the things that other humans have such as: Medical or other health care. Information to assist in making decisions. Control over their finances. A right to refuse treatment. An advocate to assist as necessary.

The Charter of Residents Rights and Responsibilities is incorporated in legislation and thus carries the weight of law. These rights are always balanced against the needs of the nursing home community as a whole. The document The Charter of Residents Rights and Responsibilities is another example outlining the principles of access and equity, specifically for the older person in residential care accommodation. The Charter of Residents Rights and Responsibilities (refer: Commonwealth Aged Care Act 1997) A. Each resident of a residential care service has the right: to full and effective use of his or her personal, civil, legal and consumer rights; to quality care which is appropriate to his or her needs; to full information about his or her own state of health and about available treatments; to be treated with dignity and respect, and to live without exploitation, abuse or neglect; to live without discrimination or victimisation, and without being obliged to feel grateful to those providing his or her care and accommodation; to personal privacy; to live in a safe, secure and homelike environment, and to move freely both within and outside the residential care service without undue restriction;

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to be treated and accepted as an individual, and to have his or her individual preferences taken into account and treated with respect; to continue his or her cultural and religious practices and to retain the language of his or her choice, without discrimination; to select and maintain social and personal relationships with any other person without fear, criticism or restriction; to freedom of speech; to maintain his or her personal independence, which includes a recognition of personal responsibility for his or her own actions and choices, even though some actions may involve an element of risk which the resident has the right to accept, and that should then not be used to prevent or restrict those actions; to maintain control over, and to continue making decisions about, the personal aspects of his or her daily life, financial affairs and possessions; to be involved in the activities, associations and friendships of his or her choice, both within and outside the residential care service; to have access to services and activities which are available generally in the community; to be consulted on, and to choose to have input into, decisions about the living arrangements of the residential care service; to have access to information about his or her rights, care, accommodation, and any other information which relates to him or her personally; to complain and to take action to resolve disputes; to have access to advocates and other avenues of redress; and to be free from reprisal, or a well-founded fear of reprisal, in any form for taking action to enforce his or her rights.

B. Each resident of a residential care service has the responsibility: 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 which is free from harassment; to care for his or her own health and well-being, as far as he or she is capable; and to inform his or her medical practitioner, as far as he or she is able, about his or her relevant medical history and his or her current state of health.

State Legislation Each state and territory in Australia has its own aged care laws and rules. You need to be aware of what is relevant in your state or territory.

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The below table provides a list of departments and websites for the states and territories of Australia Government Department Queensland Health Department of Ageing, Disability ad Home Care Department of Human Services Department of Health Department of Health Department of Health and Human Services Tasmania Department of Health and Community Services ACT Health Website www.health.qld.gov.au www.dadhc.nsw.gov.au www.dhs.vic.gov.au www.health.sa.gov.au www.health.wa.gov.au www.dhhs.tas.gov.au www.nt.gov.au/health www.health.act.gov.au State/ Territory Queensland New South Wales Victoria South Australia Western Australia Tasmania Northern Territory Australian Capital Territory

The Residential Care Manual was written in 2005 with contributions from all state and territory governments. It is based on the Aged Care Act 1997. It explains who need to do what in the aged care home and assists managers and employees to understand what the government wants. Check out the website:
www.health.gov.au/internet/main/publishing.nsf/Content/ageing-manual-rcm-rcmikndx1.htm or you can just do an internet search using the following term residential care manual aged care Australia

Privacy Act 1988 (Cth)


This legislation protects all personal information handled by business. Attached to this legislation are the ten national privacy principles which set the standard for handling personal information. The national privacy principles relate to: Collection. Use and disclosure. Data quality. Data security. Openness. Access and correction. Identifiers. Anonymity. Trans-border data flow. Sensitive information.

Privacy and Confidentiality


Below is an extract of the Aged Care Act 1997 relating to privacy and confidentiality of clients.
Division 62- What are the responsibilities relating to protection of personal information? 62-1 Responsibilities relating to protection of personal information

The responsibilities relating to protection of personal information, relating to a person to whom the approved provider provides aged care, are as follows: a) the personal information must not be used other than: i. for purpose connected with the provision of aged care to the person by the approved provider, or ii. for a purpose for which the personal information was given by or on behalf of the person to the approved provider;

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b)

c)

except with the written consent of the person, the personal information must not be disclosed to any other person other than: i. for a purpose connected with the provision of aged care to the person by the approved provider; or ii. for a purpose connected with the provision of aged care to the person by another approved provider. iii. for a purpose for which the personal information was given by or on behalf of the person; the personal information must be protected by security safeguards that are reasonable in the circumstances to take against the loss or misuse of the information.

Where privacy and confidentiality is maintained and the client is secure in that knowledge, you will more than likely have created an environment where the client and/or his/her advocate will be comfortable, and feel able to tell you of his/her individual needs and wants. The ability to speak up is empowering for the client.
For more information on the Privacy Act 1988 can be found at website: www.privacy.gov.au

Workplace Health and Safety Act 2011 Workplace Health and Safety Act 2011 applies to all workplaces. This act outlines the level of responsibility workers and employers must take to ensure their safety and the safety of others. In the workplace, you need to: follow instructions, signs and notices related to safety such as emergency evacuation procedures. use safety equipment such as gloves and safety glasses. not endanger your own safety such as climbing on an unsteady trolley follow safety signs.

to reach a shelf.

not put anyone else at risk of injury or illness for example by not reporting a chemical spill.

Workplace health and safety representative


Workplaces may have an workplace health and safety (0HS) representative who can help you if there is a problem about safety at work.

Hazard Reports
Most workplaces have forms for reporting hazards and safety problems. These forms are often called hazard report forms. Ask your supervisor where to find a copy of this form. What other regulations and laws affect the role of the carer? In a democratic society the legal system provides a framework insi de which all sections of the community interact. It establishes the rights and privileges of the individual, and makes provision for enforcement of rights and redress for wrongs suffered. All citizens should be aware of their legally defined rights and responsibilities, and should have an understanding of the laws which govern their personal and professional lives. Ignorance of a law is not accepted as an excuse for violation of that law. (Tabbners Nursing Care 3rd Edition) As well as the many laws that provide societys framework of right and wrong there are many laws and regulations which are specifically designed to ensure that those working within the aged care industry are doing so in a safe and ethical way.

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There are two (2) types of law: CRIMINAL LAW: Concerns offences against people and property. A violation of a criminal law is called a crime, and is sanctioned by some form of punishment, e.g. payment of a fine or imprisonment. CIVIL LAW: Concerns the relationship between people, e.g. trespass, contracts, negligence. Those found to have broken civil laws are usually required to pay a sum of money to the person alleging personal or property loss or damage. There are many legal principles which provide the framework on which laws are based. One of these, vicarious liability, renders the employer liable for the actions of an employee committed in the course of employment. This means that the employer may be sued for negligence if, for instance, a person/resident/client suffered damage as a result of an employees negligence, even though the employer was not on the premises at the time of the incident. While the employer is held liable, he has the right to seek a total financial indemnity from the offending employee. The legal liability of the employer does not absolve the employee from individual responsibility and legal action can be taken against the facility, organisation, and a carer, or against a carer as an individual.

Negligence, in a legal sense, describes conduct which falls below the standard required by law. If a carer
gives care that does not meet accepted standards they may be held liable for negligence; if the result of that negligence is harm to the recipient of care, the care providers are also held liable.

Defamation of character refers to any communication, written or spoken, about an individual that injures
their reputation. Carers should be extremely careful when discussing or documenting information relating to persons/residents/clients. Care should also be taken to ensure that other members of staff are not the subject of gossip or innuendo. All persons/residents/clients have a right to expect their privacy and confidentiality is respected and colleagues have a right to expect that their personal and professional reputations will not be harmed.

False imprisonment refers to wrongful deprivation of an individuals freedom of movement, e.g.


restraining or detaining a person against their will. There are some instances in which people may be legally restrained or detained, and carers need to be aware that restraint can only be performed in

consultation with the persons medical officer, and after careful consideration.
Assault and battery are considered criminal offences as well as breaches of civil law. Assault can be described as a threat to carry out a physical action, causing the person to fear for
their safety.

Battery, involves the direct intentional and uninvited application of physical contact to anothers
body.

Informed consent means that an individual has been given adequate and appropriate information to allow
him/her to understand the risks and benefits, as well as what is involved in any procedure before he/she gives consent to undergo that procedure. Legal capacity to give consent is determined by age and the individuals mental and intellectual function. The individual can withdraw consent at any time but he/she must be informed of any detrimental effects of refusal to continue. Many Acts of Parliament or legislation have associated regulations that affect workplaces, and workers.

Relevant legislation
Other laws that relate to aged care include the:

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Age Discrimination Act 2004 (Cth). Disability Discrimination Act 1992 (Cth). Disability Services Act 1986 (Cth). Home and Community Care Act 1985 (Cth). Human Rights and Equal Opportunity Commission Act 1986 (Cth). Racial Discrimination Act (Cth). Veterans Entitlements Act 1986 (Cth).

You do not need to know all the details of legislation. Although you need to know what affects your work. Your supervisor will assist you.

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APPLY UNDERSTANDING OF THE HOME AND COMMUNITY CARE SECTOR ................................................................................................


DEMONSTRATE BROAD KNOWLEDGE OF POLICY AND PROGRAMS SUCH AS HACC, DVA AND GOVERNMENT COMMUNITY CARE DIRECTIONS
There are many standards, laws and procedures that govern home and community care. As an aged care worker you need to know how these rules affect the way you are expected to work. Workplace policies and procedures are based on these rules, so you need to ensure that you follow your workplace policies and procedures.

Home and Community Care Act 1985 (Cth)


This act sets out the laws relating to delivering home and community care service. It ensures all target groups including those with challenging behaviours, migrants and the financially disadvantaged have access to these services. It also ensures that the service is accessible and delivered equitably across all regions including remote areas.

Home and Community Care (HACC)


The HACC standards can be found on the Department of Health and Ageing website: www.health.gov.au/internet/main/publishing.nsf/Content/hacc-pub_isd_nssi.htm

QUEENSLAND HEALTH FACT SHEET Home and Community Care Services


The Home and Community Care (HACC) Program in Queensland is cost shared between the Commonwealth Department of Health and Ageing, and Queensland Health. It is administered under the Home and Community Care Act 1985 (Cth) and the HACC Amending Agreement, and was established to provide support services for frail aged people, younger people with disabilities, and their carers, in their own homes. The Program aims to increase the range of care options available to the target group, assisting them to be more independent, enhancing their quality of life and preventing their inappropriate or premature admission to long term residential care. The program assists people in the target group who need basic maintenance and support services to continue living in the community with dignity. These people include: Service Types The following descriptions of service types are given as an indication of the variety of services which can be provided under the HACC Program by HACC funded agencies. The HACC Program encourages combinations of services and flexibility of service delivery to meet the assessed needs either of an individual or a region. This approach is intended to focus on what can be achieved for the user of HACC services, or the region, to meet specific needs rather than providing services based on assumptions of what could or should be provided. Older and frail persons with moderate severe or profound disabilities. Younger persons with moderate, severe or profound disabilities. The carers of these persons.

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HACC Service Types DOMESTIC ASSISTANCE AND PERSONALCARE


Homecare workers provide help with dishwashing, laundry, ironing, shopping, bill paying, cleaning, cooking and other household chores. Personal Care includes help with bathing, dressing, grooming etc. HOME MAINTENANCE & MODIFICATION Home maintenance workers can help with small repairs and basic maintenance such as fixing taps and replacing light bulbs. Home modifications include fitting grab rails and ramps and minor renovations. MEALS & OTHER FOOD SERVICES Services such as Meals on Wheels provide nutritious meals at home or at community centres, for a small fee. Depending on where the client lives, the service may include traditional, culturally diverse dishes. Other food services include assistance with meal preparation. NURSING SERVICES Professional nurses can provide nursing services to clients at home, and some community- based centres also have a nursing service.

RESPITE CARE A trained respite worker can look after the person needing care at home or centre-based respite care provides group recreation activities at a day respite centre, allowing the carer to take a break.

CULTURALLY & LINGUISTICALLY BACKGROUND- HACC SERVICE ACCESS

DIVERSE

These organisations provide a range of services to clients from a variety of cultural and linguistic backgrounds. These types of service, which are specifically targeted towards different ethnic groups in Australia, are often also part of a HACC mainstream service.

ABORIGINAL & TORRES STRAIT ISLANDER - HACC SERVICE ACCESS


These projects provide culturally appropriate services such as respite care, transport, personal care, domestic assistance and home nursing. The range of services varies between projects and many mainstream services provide service access to Indigenous people as well.

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ALLIED HEALTH SERVICES


Physiotherapy, podiatry, speech pathology, dietetics and occupational therapy can be provided at home or at a community centre. Services may vary between centres.

The various community programs include: The HACC program Community care packages Department of Veterans Affairs service

Aged Care Assessment Team Overview


The Aged Care Assessment Team undertakes assessment, provide information and support to older people and their carers to obtain a range of Commonwealth funded services to help them continue living in their own home, or enter an aged care home.

The Team provides:


Assessment and case management for individuals and carers to enable people/clients to remain living at home or enter an aged care residential home. Individual, carers and group education to enhance knowledge and skills for management of persons with dementia. Contribute to the development of local and regional aged care community services by identifying the needs and gaps. Services are provided during regular business hours Monday to Friday. No services are provided on weekends or public holidays. There is no on-call service after usual business hours. There is no cost to the consumer for services provided.

Who is the service for?


The primary client group is elderly people, and who have considerable difficulty functioning in their usual environment, and may be requiring services to continue to live in the community and without which would be at risk of premature or inappropriate long term residential care; or who are unable to remain at home and now require residential care.

Referral Process
All referrals are directed to the INTAKE OFFICER, ACAT. Referrals are accepted by: Self-referral General practitioners Family members Carers

Community services It is important that the person/client is aware of a referral being made by someone else on their behalf.

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Our Health Team


The Aged Care Assessment Team comprises of Gerontology Physicians, clinical nurses, physiotherapist, occupational therapist, clinical psychologist, Aboriginal Liaison Officer and administration staff and work in close consultation with General Practitioners and community support services. The following table lists the activities/ services the HACC program funds:

Activity or Service
Allied Health Assessment and care management

What the activity or service does


Additional services podiatry, physiotherapy, occupational therapy, speech pathology, dietetics and counselling. Assesses an individuals needs for community support service. Looks at strengths and abilities and makes sure the service helps the individual to be as independent as possible. Care plan is developed, monitored and reviewed. Delivers meals to clients homes or community centres. A case-management service with brokerage funds is available to purchase additional services for people whose needs cannot be met entirely by the usual level of HACC services. Professional nursing care is provided by a registered nurse division one, which includes clinical care, clinical assessment and education and information. Supports bathing, showering, dressing, grooming, assistance for getting in and out of bed, mobility, eating and toileting. Provides assistance with maintenance and minor repairs to clients homes, gardens or yards to ensure safe and habitable conditions. Provides carers with a break from caring responsibilities. Respite care may be provided in the home during the day or overnight or outside the home, with a worker taking the client out. Respite can also be residential where the client goes to a facility for a night, weekend or more. This service coordinates volunteers to provide services to HACC clients such as Telelink, transport, friendly visits, carer support programs, respite and camps.

Delivered meals and centre-based meals Linkage

Nursing: e.g. district nurse Personal care Property maintenance Respite: home, community and overnight

Volunteer coordination

Governments fund a range of community care packages to assist people who need care to stay at home. A case manager administers most packages. There are different packages funded for different groups of clients and clients with different levels of care needs. The following table outlines some of these.

Package
Community aged care package (CAP) Extended aged care at home (EACH) package Extended aged care at home dementia (EACHD) package Linkage

Who is it for
These are for older people who live at home with low-level care needs that cannot be met by basic home and community care services. Extended aged care at home are for high care needs for those who live at home. Extended aged care at home are for high care needs as a result of dementia for those who live at home. A case-management service with brokerage funds is available to purchase additional services for people whose needs cannot be met entirely by the usual level of HACC services. Helps carers by giving them regular breaks from caring, includes education and support to meet their needs and those of the person they care for.

National respite for carers program (NRCP)

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Package
State or territory-funded disability packages

Who is it for
Support children and adults with disabilities and their families to obtain the support they need at home. Note these may differ from state to state.

Department of Veterans Affair services (DVA)


This service supports Australians who have served in the military as well as war widowers and widows. DVAs services include: pensions, health care, housing, counselling, community care and residential care. Similar services are provided as HACC programs.

COMPLY WITH DUTY OF CARE IMPLEMENTATION COMMUNITY SETTINGS AND WORKER ROLES WHAT IS DUTY OF CARE?

IN

HOME

AND

The following is an example of who has the duty of care. Assess and see if you agree with the outcome. Lord Atkins, presiding over a court case in England that involved so called "damages to a person who had become ill after drinking ginger beer from a bottle which contained a decomposed snail, decided that the manufacturer, although not present when the damage occurred, had a duty of care to the people who consumed his product. His Lordship said: The rule that we are to love our neighbour becomes, in law, you must not injure your neighbour; and the lawyers question, Who is my neighbour? receives a restricted reply. You must take care to avoid acts or omissions, which you can reasonably foresee, which would be likely to injure your neighbour. Who, then, in law is my neighbour? The answer seems to be persons who are so closely and directly affected by my act that I ought reasonably to have them in contemplation as being affected when I am directing my mind to the acts or omissions which are called in question What is duty of care and how does it impact on you as a carer? You have a duty of care to not only the people in your care/residents/clients but to a slightly lesser degree your co-workers and employers. Duty of care statements are often incorporated into the code of conduct. All employees will be asked to sign a code of conduct when they commence working for the organisation and this says that you will abide by this code in your work and behaviours for the facility. When agreeing to the code or duty of care you assume culpability for person/resident/client care and wellbeing within the scope of your qualification. Important points: Be acutely aware of the duties you are and are not allowed to perform with your qualification. Make sure that the code of conduct you agree to is the standard you believe to be acceptable. Make sure that your job description outlines the duties and level at which you are to operate. Make sure that others do not compromise your duty of care. Make sure that the code of conduct has the best interest of the people in care/residents/clients and workers as a priority. You are encouraged to think carefully about the standard of care you wish to deliver to people/residents/clients and how that can be encouraged and supported by the code of conduct and/or the duty statement of the organisation.

These issues should be considered at the interview point and prospective staff are encouraged to research the organisation before going for interview to make sure this is the kind of care facility you wish to work in.

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Applying duty of care


It is important to understand how duty of care applies to your role. While all aged care roles have a duty of care, the nature of the duty is different depending on your level of responsibilities. You need to know your responsibilities are for your role. Your job description outlines your duties, tasks and level of authority. In most roles requiring a Certificate III qualification, an aged care worker would be expected to: Work in a way that does not put them, their co-workers or residents/ clients at risk. Treat residents/ clients as individuals with the right to make up their own minds. Follow instructions provided by the supervisor or workplace. Be respectful to residents/ clients. Arrive at and leave work on time. Look for and report things that may cause harm.

Breaching duty of care


You are breaching your duty of care if you: Do an activity without necessary training or experience. Do not abide by the workplace rules. Do not follow a care plan. Fail to meet the expected standards of care. Fail to record an incident. Record an incident untruthfully.

Skip important steps in tasks or skip whole tasks when providing care. You are breaching the residents/ clients rights if you dont: Treat them with respect and courtesy. Follow safety regulations.

All care and support services delivered to people who are aged or disabled must adhere to legislation. This includes the policies and procedures of the workplace and the program guidelines provided by the government. Following organizational policies and procedures include such things as: Checking equipment. Communicating with residents/ clients and others. Following emergency and security procedures. Handling infection control and wastes. Reporting hazards. Reporting incidents. Understanding cultural differences. Using correct manual handling.

DEMONSTRATE BROAD KNOWLEDGE OF AGEING IN PLACE


Positive Ageing:
Positive ageing is not a condition nor is it an official title; it is simply a desired attitude towards the frail and aged in our community. This is to include care recipients and those who are simply beginning to feel the effects of the ageing process. Ageing as a condition should be considered as a stage of life and part of living rather than the end of a persons useful existence. We need to be constantly considering the positives which can be extracted from the aged with the community.

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The older person wants to stay in their own home and expect to receive help to be able to do so. Most do not want to move into aged care facilities unless they have to:

To support this government currently pays for:


Care at home. Allied health. Respite care. Day centres that provide social activities for the older person. Case management services.

Workers using the ageing-in-place model can:


Support the older person to carry out their activities of daily living (ADLs). Encourage the older person to remain active by helping them take up a hobby or encourage them to participate in their own ADLs. Encourage the older person to retain their social network of friends. Provide information about services. Work with a case manager to assess the older person and their family on a regular basis to help the older person stay as independent as possible.

DEMONSTRATE COMMITMENTS TO THE PHILOSOPHY OF POSITIVE AGEING ..............................................................................................


TAKE INTO ACCOUNT PERSONAL VALUES AND ATTITUDES WHEN PLANNING AND IMPLEMENTING WORK ACTIVITIES
What is your own attitude to ageing?
There are several definitions of the word old. Depending on which dictionary you look at, you may find terms like wise, familiar, and having much experience, along with the more readily accepted worn out by age or far advanced in years. In answering th ese questions we have assumed that old age is measured in years, but there are many senior citizens who, although far advanced in years, are most definitely not worn out by age. Older people have views and values. Sometimes they will be the same as yours, while other times different. You should be aware of what older people value. Views and values are the things we believe in and the way we feel about life. A view is what you think about something, while a value is what you thing is important. Views and values come from many places and they change over time. Being aware of how your views and values and how they can influence you or others in the workplace is of great importance. In your job you need to get along with older people, other co-workers and your supervisor. If you think your views may upset someone then keep them to yourself. Your views should not affect how you work nor should they upset others. If you have issues working with an older person, talk to your supervisor. You may be able to plan your work differently. It is a good idea to learn about the views and values of the older people you work with. Find out what they are interested in and try to do things to suit the resident/ client where possible.

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Little changes can make a big difference to an older person. If you make changes the older person does not like, it might upset them. If you make changes they like, it may help them and make them happy. Always remember to discuss changes with them. It is not your job to change views and values of the older person. Your job is to work with them and help with their care. You need to accept that the older person may have different views and values to you. Try to understand their view and values by talking with them to learn more. Just listen and accept that each person is an individual.

Reading #3 The Challenge of Ageing by Marion W. Shaw Ageing and Attitudes


Apart from general policy considerations, any discussion of ageing and the provision of services must have regard to attitudes. Attitudes and values provide foundations for the beliefs that shape and guide our perceptions of, and responses to, social groups like the aged, the disabled and delinquents. If our responses are based on negative, stereotyped attitudes, the result is likely to be rejection and stigmatisation. Australian population projections suggest that 16% of our total population will be 60 and over by the year 2001 with a disproportionately high rate amount of overseas born. For all countries the social, economic and political implications of these changes are enormous, yet there is widely spread confusion, complacency and failure to own up to how little we understand old age. The situation is at once compounded and exacerbated by deeply entrenched ageism, which acts as a barrier to action and the development of appropriate policies and programmes. Older people and their advocates frequently experience this barrier as a discriminatory practice that tends to exclude or prevent access to a range of services and activities enjoyed without restriction by other age groups. By 2020 there will be more 65 year olds than 1 year olds.

RECOGNISE AND MANAGE AGEIST ATTITUDES THROUGH THE SUPPORT OF THE APPROPRIATE PERSON
Ageism
In 1973, Robert Butler and Myrna Lewis used the term ageism to describe a process of systematic stereotyping or discrimination against people because they are old, just as racism and sexism accomplishes this with skin colour and gender. Old people are categorised as senile, rigid in thought and manner, old fashioned in morality and skills. Ageism allows the younger generation to view old people as different from themselves. Radford (1987), describing the visual, physical and mental derivations of the stereotypes, states Ageism is practised by the community, the professions, often most sadly by the elderly themselves if they too come to believe the myths about themselves on which it is built.

Age Discrimination
Age discrimination is a denial, based on chronological age, of equal opportunities on the basis of assumptions than cannot be validated on other grounds. As Equal Opportunity Commissioner Williams notes in her recent report (1989) in Western Australia. Discrimination arises because of incorrect assumptions about peoples needs and abilities based on their chronological age.

Ageist views
Ageist views can come from anywhere such as: Family members who think the older person cant make their own decisio ns. Personal care workers and/ or supervisors who do not let residents/ clients participate in making decisions about their care. Venue operators who try to discourage the older person from attending their venues by not providing wheelchair access. Health care workers who assume that the older person needs more help than they really do.

Everyone should be treated fairly even if they are unable to do some things themselves. People should not assume that all older people are the same just because they are old.
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RECOGNISE THE IMPACT OF CHANGING EXPECTATIONS OF CLIENTS, THEIR FAMILY AND THE WIDER COMMUNITY IN RELATION TO SERVICE DELIVERY
A consumer is a person who uses a service. The older person who uses aged care services are consumers as they expect the services to meet their care needs regardless of whether they pay for the service or not. If the services do not meet the need of the older person, then they can try to change services or use a more suitable service.
Many services make it easy for the older person to have their say in a number of ways, for example: Meetings. Surveys. Chats with staff. Complaints forms. Suggestion forms. These need to be listened to. High quality aged care services understand that meeting individual needs is important. They also ask for feedback and ask the older person about their individual needs.

The Residential Care Manual 2009 states areas where residents of aged care facilities must be consulted or asked for their opinion. Some of these areas include: Food choices must take into account the likes and dislikes of the residents. The older person needs to be consulted in the planning and development of activity programs. Consultation needs to take place with allied health professionals. Living arrangements need to be discussed. The older person has a say in how the service is run. Every person in the aged care facility must receive a copy of the statement of residents rights. The HACC guidelines for community programs also ensure that the older person is consulted about services. Aged care workers can help the older person by listening and talking to them about their likes and dislikes. Pass on problems and issues of concern to the supervisor as this helps improve the services delivered to the older person. It will also ensure that the older person feels that they are being heard and listened to.

CONDUCT WORK THAT REFLECTS AN UNDERSTANDING OF THE INDIVIDUALITY OF AGEING


Each individual age in different ways, therefore they will have different needs, like different things and behave in different ways. By understanding these differences, you will be better able to do your job and assist the person. When you are working, you need to: Know that people change. Learn the name of each older person you work with. Learn about their needs. Learn about their likes and dislikes. Talk to other team members or your supervisor about problems. In doing these things it will enable you to do a better job. Even the older person likes to be treated as an individual. They will feel you understand them.

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The following table outlines some ways you can allow for the difference between people:

How you can allow for differences


Activities Conversation Some people like to be busy. They like to do many activities, while others prefer to sit, read, and have quiet times. There are those individuals who like to talk about a variety of subjects news, family, history etc, while others will have trouble remembering just what you said. Try to remember what different people like to talk about and do some research so you can talk about various topics. While some older people need help to move around. Some can be very unsteady on their feet and trip, stumble or get tired very easily. Be aware of a persons mobility so you are able to assist if required. Your tone of voice has an impact when talking with the older person. The reason for this is numerous their range of hearing pitch/ tones is affected in the ageing process, they could have impaired hearing. Knowing who has these challenges is important. Speak clearly and ensure that the older person has clearly understood what you had to say.

Movement

Voice

Case Study Mrs. Wattle misses her friends. She grew up and has lived in the country all her life. She was part of the Country Womens Association and a member of the local art and craft group. She did a lot of fund raising for the area and region and has been involved in many organisations and clubs. Her son has brought her to the city to live in a retirement resort. She has become very sad, feeling that life has no purpose any more. Her eyesight is failing and her ability to read or write to her friends has declined. Her son rarely comes to see her due to his change of jobs and constant travel. What are some ways you could assist Mrs. Wattle to feel better about ageing? Write down 4 options or discuss with your trainer.

CONDUCT WORK THAT MINIMISES THE EFFECTS OF STEREOTYPICAL ATTITUDES AND MYTHS ON THE OLDER PERSON
What can we learn from the elderly?
Today, young people have the potential to live long and productive lives in an increasingly ageing society. However, they are more likely to learn about the negative than positive aspects of ageing. While schools actively address issues of racism and sexism, ageism is rarely considered in the classroom. Unless young people are taught the positive aspects of ageing, ageist humour, literature and media will continue being their primary sources of information about ageing.

These sources tend to perpetuate ageist myths, stereotypes, and discriminatory behaviours towards older people no matter where they are living. What are some of the myths about ageing and aged people? The following are some commonly believed myths and facts in relation to the elderly: Myth
Older people are a burden on society

Fact
Older people contribute to society in a positive way. Institute of Family Studies research has demonstrated that older people are more likely to provide financial and practical assistance to families than to receive it. This assistance includes childcare, financial help and help with the cost of tertiary education for children and grandchildren. Older people are also active in their communities. 24% of people aged 55 and over contribute their time as volunteers. Nearly 38% of people aged 55+ care for children, or for frail or ill relatives and friends. 11.8% of people aged over 60 continue in paid employment.
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CHARLTON BROWN

Myth
Older people are all the same.

Fact
Older people are as diverse as any other age groups. Each generation of older people brings its unique historical and cultural experience with them as they age. As in the rest of society, older people have different backgrounds and beliefs and like to be treated as individuals. Physical ageing is a slow, gradual, life long process. The rate of physical ageing among humans varies widely, dependent upon a complex interaction of genetic, physical, lifestyles, social and environmental factors. The greatest decline in the human body occurs between 30 - 40 years of age. Disabilities, sensory loss, and chronic diseases increases with age but are not inevitable ageing conditions. The majority of seniors live independently and require no assistance with daily tasks. Approx 130,890 older people live in residential care facilities in Australia. This means that 95.7% of people over the age of 60 are living in the community. Older people with a disability and living in the community are more likely to receive assistance from their spouse or partner than from formal community services. Note: These are slightly older statistics however it is an indication of the range of care needs that the elderly require in our communities. This qualification will provide skills in a range of care options, in-home care, community care, residential aged and disability care. The majority of older people do experience some degree of memory loss; Alzheimers disease is the most common of the cognitive diseases which affect the frail and aged. However, the incidence of severe memory loss is greatly increased over the age of 80 years. Learning is a life-long pursuit. Older people continue to learn from life and to pursue their interests. Older workers benefit from continuous training and retraining to the same extent as younger people. Behaviour modification is a learning experience; the only difference in learning for the elderly is the way in which we deliver the information/teaching. Sexuality is a characteristic of people of all ages. Older age does not mean a loss of capacity for, or interest in, sexual expression. However, opportunities for sexual interaction may be reduced by the death or disability of a partner or changes to accommodation that affects privacy. Most retired people are socially engaged and maintain active independent lives. A 1997 Seniors Cared Survey indicated that 75% of members sampled (60+) had travelled that year. A large percentage of persons/residents/clients in residential aged care had been travelling or had just returned from travelling when they experienced an acute episode which resulted in them being admitted into care.

Ageing means inevitable physical and mental decline.

Older people need looking after.

All older people eventually become senile or all older people have dementia. You cannot teach an old dog new tricks.

Older people are not interested in sex or sexuality. Older people are lonely and do not want to socialize outside of their homes.

Good work practices


Besides what you do every day in assisting your residents/clients and how you perform your work there is also another important aspect to your work. Having a good attitude helps you be able to work as part of a team. It helps you get along with others. Your working relationship with others will vary for example you may only see the senior manager at meetings while you will interact with your supervisor on a daily basis. What you do at work and how you do it can make a big difference to the people around you. When planning care, care workers need to be aware of these popular myths and the effect they can have on the attitude of the person/resident/client. In many cases the myth is responsible for misdiagnosis of condition.

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For example:
Mrs. Jones daughter reports that almost overnight her mother became disorientated and aggressive, not wanting any one to assist or even visit her. She was not attending to her personal hygiene as she always had and was not answering the telephone or the doorbell. The daughter thought this was a natural process of ageing and that mother, as with all women o ver 70 years of age, had got dementia. What she was not recognising is that her mother had a temperature and was in substantial pain when she was voiding. Mrs. Jones had in fact contracted a urinary tract infection which does alter behaviour and can develop into much more serious situation if left unattended. When she was diagnosed, after a course of antibiotics she returned to her old self. A community nurse attended 3 times per week to make sure her recovery was complete and to educate her in the importance of nutrition and hydration for the over 70s in particular. Let us not always jump to the conclusion that the reason for all conditions in the elderly is dementia. We dont get dementi a overnight this is a slow and deliberate developed condition.

APPLY UNDERSTANDING OF THE PHYSICAL AND PSYCHOSOCIAL ASPECTS OF AGEING ................................................................................................


TAKE INTO ACCOUNT PHYSICAL CHANGES ASSOCIATED WITH AGEING WHEN DELIVERING SERVICES
The Process of Ageing
Ageing is a highly individualised process that affects each person in unique ways. Ageing is the result of the interaction among genetic endowment, environmental influences, lifestyles and the effects of disease processes. Therefore, people become increasingly diverse as they age, and it is difficult to predict with certainty a persons health status or functioning level on the basis of chronological age alone (Gerontological Nursing, Mate son, McConnell and Linton). There is much truth in the old saying that Birth is the beginning of Death. The process of ageing is a combination of many changes to the individual which begin from the time of conception. All processes involve change, and the ageing process involves many physical, psychological and social changes that combine in differing variations in different individuals to produce the many differing needs and abilities we see in our ageing population. Consider your own growth. Once you were a baby and went through all of the milestones (learning to sit, crawl, walk, and talk) but due to your nutrition and environment, you have grown into an adult. Many things have happened to you along the way going to school, developing friendships, being part of your community, perhaps even buying a home. Imagine now that you can no longer care for yourself. How would you feel scared, vulnerable, and unsure. The process of ageing is about going through all of the milestones in life birth, growth, relationships, health to death. The following table shows changes encountered and the effect they have on the person/resident/client. As a care worker, you will need to address how these changes will impact on the delivery of care to the person/resident.

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Body system Integumentary

Changes
Loss of collagen in the dermis Loss of subcutaneous fat Loss of elasticity Atrophy of sweat glands Number of blood vessels decreases Thinning and loss of hair Thickening of nails Pigmented or non pigmented lesions may appear Progressive muscle atrophy Tendency for muscle cells to be replaced with fibrous tissue Thinning of bone (osteoporosis) Arthritic changes Changes in intervertebral discs Change in cardiac function Loss of elasticity of blood vessel walls

Effects
Folds, lines, winkles appear Skin fragility Drier skin Increased sensitivity to cold Cosmetic implications More difficult to cut Cosmetic implications Weakening of muscle strength Fractures more common Stiff and painful joints Gradual loss of height and characteristic stoop Loss of mobility Heart is less able to respond effectively when under stress Increased pulse and systolic blood pressure Decreased peripheral arterial blood supply and poor venous return Wound healing takes longer Slower to produce leukocytes and erythrocytes in response to antigens and blood loss Breathing less efficient Greater tendency to develop atelectasis/pneumonia Less reserve capacity and tolerance for exercise and stress Reduced ability to eliminate drugs More frequent voiding Incontinence may develop Loss of teeth Swallowing may be more different More difficult to digest fried/fatty foods Constipation Diminished appetite Decreased ability to metabolise certain drugs May affect personality and/or behaviour Slower reaction time Diminished reflexes Decreased sensitivity; to pain, heat/cold sensation Diminished sense of movement and position Gradual reduction in ability to hear high tones Decreased depth perception, night vision, visual fields adaptation, accommodation acuity Increased sensitivity to glare

Musculoskeletal

Cardiovascular

Haematopoietic

Defence mechanisms decline Bone marrow and lymphatic tissue have less functional and reserve capacity Progressive decrease in the thickness of alveolar walls and in elastic recoil

Respiratory

Genitourinary

Loss of nephrons leading to decreased kidney function Bladder capacity reduced Bladder control may be unstable Atrophy of gum and bone tissue Reduction of saliva Decreased secretion of digestive juices Decreased intestinal motility Decreased sense of taste and smell Reduced weight and regenerative capacity of the liver Decreased number of nerve cells in specific areas of the brain Nerve conduction slower Decreased kinaesthesia Cochlear degeneration

Gastrointestinal

Nervous

Special senses

Increased size and rigidity of the lens, reduced density of lens

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Physical Effects of Ageing


From the previous table we can see that ageing may cause numerous changes to our body systems and that each of these changes may have one or more corresponding effects e.g. degeneration of the cochlear of the ear (a change in the special senses) results in a gradual reduction in the ability to hear high tones (the effect from that change). For carers, it is important to understand that although we may not be able to reverse the changes associated with ageing, we can usually find strategies to minimise the effects of those changes. In fact, the most valuable skills a carer can have are those of being able to identify the effects of changes associated with ageing or illness and taking appropriate measures to assist the ageing person to alleviate them. From this you have discovered just a few of the many needs of ageing people and you have thought about what you, as a carer could do to alleviate those needs. Although we, as carers, believe we have the perfect solution to a problem, sometimes that solution may not be perfect for the ageing individual we wish to assist. Examples of how physical changes may be affect personal care services Physical changes Loss of muscle strength e.g. long illness, being confined to bed for a long time Affects to doing tasks Dressing Mobilisation Toileting Transfers Washing Dressing Mobilisation Toileting Transfers Washing Eating Drinking Oral hygiene Dressing Mobilisation Toileting Transfers Washing Eating Drinking Oral hygiene Strategies Provide extra physical support Use an aid e.g. Shower chair Consult a physiotherapist

Loss of limb control or movement in a body part e.g. stroke

Provide extra physical support Use an aid e.g. Shower chair Consult a physiotherapist

Problems with swallowing or chewing e.g. post stroke, other neurological conditions Tremor or unsteadiness in movements e.g. Parkinsons disease

Consult a speech pathologist Provide vitamised or thickened meals as per speech pathologist recommendations Assist with physical tasks as needed Consult health professionals Provides extra physical support Use aids and equipment as needed wheelchair, built-up spoon, special cups, dressing aids Watch for hazards

Being able to meet the changing needs of the older persons physical changes affects how services are provided to the person. Some individuals will require a lot of help due to the body changes while others will not need a lot of help at all. There are a number of aids that are available to assist the older person maintain their independence.

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Aids

Description
Wheelchairs can be manual or electric. They can also be pushed by another person.

Walking frames come in various styles to meet the needs of the individual. Assist the person to mobilise Physiotherapists can assist with the correct style for the older person. Walking sticks vary in styles Assist the person to mobilise Physiotherapists can assist with the correct style for the older person. Dressing aids for doing up buttons and getting dressed

RECOGNISE AND ACCOMMODATE THE OLDER PERSONS INTERESTS AND LIFE ACTIVITIES WHEN DELIVERING SERVICES
Aspects of ageing include physical and emotional changes. Having a healthy lifestyle is important at every stage of life. Human needs are many and varied and it is helpful to group them in order to understand them. The humanistic psychologist, Abraham Harold Maslow suggested there are a number needs and developed the Maslow hierarchy of needs. The lower the needs in the hierarchy, the more fundamental they are and the more a person will tend to abandon the higher needs in order to pay attention to sufficiently meeting the lower needs. For example, when we are ill, we care little for what others think about us: all we want is to get better.

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Refer: Maslows Hierarchy of Needs

Physiological needs are the basis and form the foundation on which fulfilment of all higher needs rest. The person may never fully satisfy each need fully, yet still be able to reach to an extent to move onto the next level. Physical needs are the primary needs and dominate.

The five needs


Physiological needs are to do with the maintenance of the human body. If we are unwell, then little else matters until we recover. Safety and Security needs are about putting a roof over our heads and keeping us from harm. If we are rich, strong and powerful, or have good friends, we can make ourselves safe. Love and Belonging needs introduce our tribal nature. If we are helpful and kind to others they will want us as friends. Self-Esteem needs are for a higher position within a group. If people respect us, we have greater power. Self-actualization needs are to 'become what we are capable of becoming', which would our greatest achievement.

Three more needs


These are the needs that are most commonly discussed and used. In fact, Maslow later added three more needs by splitting two of the above five needs. Between esteem and self-actualization needs was added: Need to know and understand, which explains the cognitive need of the academic. The need for aesthetic beauty, which is the emotional need of the artist. Self-actualization was divided into: Self-actualization, which is realizing one's own potential, as above. Transcendence, which is helping others to achieve their potential.
The Five needs - http://changingminds.org/explanations/needs/maslow.htm

There are many ways for the older person to stay physically healthy and promote psychosocial wellbeing. Physical changes for the older person can be numerous and individual. Some of these changes can be: Structural having arthritis causing joints to be inflamed and cause pain, reduced mobility.
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Body function Decreased blood flow to vital organs due to changes in the size and walls of the blood vessels. Changes in the gastrointestinal system ingestion is less efficient with decreased and thicker saliva, and sometimes teeth and mouth problems.

Psychosocial changes relate to the way the older person deals and interact with the world. They involve both psychological and social aspects. These can include: Changes of work status or prestige in the community. Nature of relationships loss of a partner. There are many ways that the older person can stay physically health and promote psychosocial wellbeing. Maintaining good physical health can include: Regular medical checkups. Eating a range of healthy foods. Exercise regularly. Not smoking. Alcohol intake is in moderation. Drink plenty of water to prevent dehydration. Monitor weight. Use safety aids if required. Use over the counter medicines safely. Continence management

Continence is the ability to control the bladder and bowels. Loss of continence can be hard for the older person to manage. It is often very embarrassing for the older person and they often do not like to talk about their continence problems. Things that the older person can do: Wait until the bladder is full before using the toilet. Drink at least 6 8 cups of water or fluids (unless on a restricted fluid intake) fluids can also include juice, jelly, milk, cordial and soft drinks. Limiting caffeine found in coffee, coke, pepsi and tea. Limiting alcohol. Doing regular pelvic floor exercises this includes both male and female. Maintaining good psychosocial health suggestions can be seen in the following table Psychosocial area Exercise the mind Some Strategies Play word games Doing crosswords Reading Use the mind to remember things Think about challenges and problems Make time for friends Join community groups and activities Volunteering Travel Share a meal with someone Knowing your neighbours Keeping regular appointments with health professionals Get out of the house

Meeting new people

Staying in touch with others

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The right support

Use the phone, email, letters or face-to-face visits Stay in touch with a medical practitioner Know what feels normal Deal with health or psychological problems promptly Use family support Find the right help from professionals to deal with issues and problems Use an advocate when needed to support rights

Maintaining health in the community


As an aged care worker, you can assist the older person to maintain their health by: Reading their care plan. Staying within your job role. Some ways you can help maintain the older persons physical health at home Area Look after their physical health Some Strategies Does the person get any physical exercise? Are they able to go for a walk? Are they part of an exercise group? Can you assist them to find a way of exercising that is safe and fun.

Checking their eating and drinking habits

Check the fridge - is it working? The food in the fridge - is it fresh or stale? Are there any fresh fruit and vegetables? Are they able to get fresh food? Can they cook safely? If not, are they getting meals from somewhere else, be it family or meals on wheels? Are they drinking too much alcohol or smoking too much? Talk to your supervisor and / or team members before discussing any lifestyle changes with the older person. Read their care plans and make sure you understand their needs and problems.

Dealing with emotions of the older person can be a challenge at times. They can at times have troubles with feelings of sadness, loneliness or isolation. The older person may only need some support and kindness to get through a hard time. There are times where the support the older person requires is beyond your scope of practice. They could require assessment by a medical doctor or psychologist. You need to inform your supervisor if you notice that the older person has any of the following signs: Withdrawal from activities. Constantly sad. Problems sleeping. Changes to behaviour. Lack of appetite. Lack of interest in what is happening around them. Unexpected comments or behaviour. Changes to mood. Feelings of anger, despair or hopelessness. Other problems of signs that worry you. Remember you are part of a team, ensure you work within your scope of practice and follow organizational procedures.

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The following is a fact sheet of Understanding Depression from Beyondblue the national depression initiative - Australian

Understanding depression
For other fact sheets in this series visit: or Lifelines Just Ask on 1300 13 11 14

www.beyondblue.org.au
In most cases, depression will go on for weeks or months if left untreated. If it isnt properly treated, depression is highly likely to recur. WHAT MAKES A PERSON MORE AT RISK OF DEPRESSION? Some events or situations have been linked with depression: Family conflict Isolation or loneliness Unemployment Having a serious medical illness Drug and alcohol abuse Brain and chemical changes Depression often runs in families Its important to remember that each person is different and it is often a combination of factors that puts a person at risk of depression. HOW COMMON IS DEPRESSION? Very common. Around one million Australian adults and 100,000 young people live with depression each year. On average, one in five people will experience depression in their lives; one in four females and one in six males. WHAT ARE THE TREATMENTS FOR DEPRESSION? Depression is often not recognised or treated. Different types of depression require different types of treatments. This may include physical exercise for preventing and treating mild depression, through to psychological and drug treatments for more severe levels of depression. PSYCHOLOGICAL TREATMENTS Psychological treatments deal with problems that particularly affect people with depression, such as changing negative patterns of thinking or sorting out relationship difficulties. Cognitive Behaviour Therapy (CBT) is used to correct negative thought patterns. Interpersonal Therapy (IPT) is used to improve relationships. MEDICATIONS People who are depressed often feel physically unwell. Antidepressant drug treatments relieve the physical symptoms of depression. Drug treatments for depression are not addictive. Many people worry about the potential side effects of antidepressant medication. Its important to know that when depression isnt treated effectively, physical health often gets worse.

Depression is more than just a low mood its a serious illness. People with depression find it hard to function every day. Depression has serious effects on physical and mental health. HOW DO YOU KNOW IF A PERSON IS DEPRESSED AND NOT JUST SAD? A person may be depressed, if for more than two weeks they have: Felt sad, down or miserable most of the time OR Lost interest or pleasure in most of their usual activities. AND experienced symptoms in at least three of the following categories: 1) Behaviours Stopping going out Not getting things done at work Withdrawing from close family and friends Relying on alcohol and sedatives No longer doing things they enjoyed Unable to concentrate 2) Thoughts Im a failure Its my fault Nothing good ever happens to me Im worthless Lifes not worth living 3) Feelings Overwhelmed Guilty Irritable Frustrated No confidence Unhappy Indecisive Disappointed Miserable Sad 4) Physical Tired all the time Sick and run down Headaches and muscle pains Churning gut Sleep problems Loss or change of appetite Significant weight loss or gain

THE MOST IMPORTANT THING IS TO FIND A TREATMENT THAT WORKS.


Many things that people try dont treat the cause of the illness. For example, sleeping tablets or simple counselling are ineffective, even though they may provide temporary relief. There is a range of treatments that are proven to work. Each person needs to find the treatment thats right for them. WHAT CAN BE DONE TO HELP? People with depression dont get better on their own. They may need to get help with the support of their family and friends. YOU CAN HELP SOMEONE BY: Assisting them to get information from a website or library Suggesting they go to a doctor or health professional Assisting them to make an appointment

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Accompanying them to their appointment with a doctor or health professional Following them up after the appointment Encouraging or getting them involved in social activities Discouraging them from treating themselves with alcohol or other drugs. IT WOULD BE UNHELPFUL TO: Put pressure on them by telling them to snap out of it or get their act together Stay away or avoid them Tell them they just need to stay busy or get out more Pressure them to party more or wipe out how theyre feeling with drugs and alcohol If you or someone you know needs help, talk to your fami ly doctor or another health professional about getting the RIGHT help. RECOMMENDED DEPRESSION WEBSITES www.beyondblue.org.au Information on depression, anxiety and bipolar disorder www.ybblue.com.au beyondblues website for young people moodgym.anu.edu.au Cognitive Behaviour Therapy to prevent depression www.bluepages.anu.edu.au Information on depression www.crufad.unsw.edu.au Information on depression and anxiety

www.infrapsych.com
Information on a range of mental illnesses beyondblue: the national depression initiative, 2005. PO Box 6100, Hawthorn West VIC 3122 T: (03) 9810 6100 F: (03) 9810 6111 E: bb@beyondblue.org.au W: www.beyondblue.org.au

The concepts of maintaining health, psychosocial health remain the same regardless of where the resident/ client lives - in the community or an aged care facility. For veterans their experiences of life have often involved some form of wartime experience. This often leads to added psychological problems and their needs may require additional understanding by the aged care person in how they can assist them. Maintaining the health of people with acquired brain injuries An acquired brain injury (ABI) is an injury that causes damage to the brain. There are many causes such as: Trauma - Blow to the head. Car accident. Complications of alcohol abuse. Stroke. Depending on what part of the brain has been injured by the ABI, it can influence such areas of behaviours, decision-making, emotions, and memory of the person.

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Some of these changes can be: Area of influence Emotional state Possible display of reactions, actions Act on impulse Overreact to issues or problems Have poor judgment Have difficulty understanding complex social situations Misread social cues and information Unable to control their impulses May not think clearly Problems with memory Challenges with making good choices Trouble with managing emotions Dont think before doing things

Behaviour

Ways in which an aged care worker can help with healthy lifestyle choices: Provide information about lifestyle choices. Help with referrals to groups. Ensure the client has access to: Fresh food. Are safe and enjoy exercise. Activities that make them think. Drinks and healthy snacks. Remember: Work within your scope of practice. Report to your supervisor. Work with your co-workers. If unsure then seek assistance or advise from your supervisor.

ASSIST THE OLDER PERSON TO RECOGNISE THE IMPACT PHYSICAL CHANGES ASSOCIATED WITH AGEING MAY HAVE ON THEIR ACTIVITIES OF LIVING
Aged care services help the older person access and manage their own physical ability to perform their ADLs (activities of daily living). They help them to understand the impacts of changes and problems of ongoing ADLs. This can be done in many ways such as: Formal assessments. Observations. Discussions with the older person, their family, medical professionals and other advocates. It is important that the older person is part of these assessments and is involved with the gathering of information, planning and implementing of changes. The team members need to ensure that the older person understands they are not there to take away their independence but to assist them to maintain it by providing additional assistance. The embarrassment of needing assistance to do things like showering, which is very personal creates emotional challenge of being able to accept that they need assistance. As aged care workers encouraging the older person to do as much for themselves as possible and finding ways of adapting other things to assist in how they attend their ADLs has a huge impact for the older person. Giving choices about how they would like assistance to achieve their ADLs makes a difference to the older person maintaining their independence. If the older person thinks the impact of changes means that they can no longer do something for themselves, they stop trying. They may need the advice of a doctor or occupational therapist. Ensure that the older person is not at risk of injury while trying to do a task. If you are in doubt then seek advice from your supervisor.

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The following table shows how the physical problems of aging affect a persons ability to ADLs Physical Problems with continence Impact on activities of daily living (ADLs) May need clothing or bedding changed May need pads or protective clothing May need help with catheter care May require referral to a doctor, physiotherapist or continence nurse Problems with buttons or zippers Trouble with cutting fingernails or toenails Loss of enjoyment doing activities e.g. Craft Trouble opening containers Problems with finding things Trouble with remembering the steps to a task Decreased safety around the house Increased risk of getting lost Problems with getting items out of the cupboard Not able to reach or pick up objects Problems with dressing Trouble lifting or moving objects e.g. Shopping bags Increased risk of injury or falls Trouble maintaining the house and garden Problems reading directories, timetables, medication labels Trouble filling in forms Increased risk of falls, bumps and knocks Loss of enjoyment of reading books or magazines Problems with watching television Problems with answering the phone Not able to respond to alarms Trouble hearing conversations Problems with watching television Impact on social network and friendships

carry out their

Loss of fine motor skills (small movements, especially the hands and fingers) Memory problems/ dementia

Loss of flexibility

Loss of muscle strength

Reduced vision

Reduced hearing

There are numerous aids and equipment that can help the older person maintain their independence. Many of these items are very simple to use and inexpensive items that can make a huge difference to tasks. For example: Pick-up-stick; this is a stick with a griping mechanism on the end. It enables the person to reach and pick up items from the floor. Other aids or special tools/ equipment can include: armchairs that tilt to enable ease of standing/ getting out of the chair. remote controls to turn lights on and off. lids for cups to prevent fast flow of liquid or hot liquids being spilt. stove guard to prevent pots being pulled off the stove accidently. page turners to help turn the pages of books or magazines. book stands which enable the ease of reading without having to physically hold the book or magazine. wrist supports to help promote a stronger grip. laundry trolleys to carry the washing basket to the cloths line. rubber mats to prevent bowls or plates from slipping on a surface/ table. grips for helping to open jars or bottles. dressing and grooming tools that assist in being able to dress and groom oneself.

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This is an endless list of items to assist the person. There are a number of places that one can go to seek information or assistance with aids and equipment. Sources of information can be found for example: internet. local chemist. independent living centres. yellow pages of the phone book. medical professionals e.g. occupational therapist, doctors or physiotherapist.

As an aged care worker, its important that you have an awareness of these things and if you are unsure then seek assistance from your supervisor. When working with the older person you also need to be aware of the following and advise your supervisor when changes happen regarding the older persons ADLs: Are asked by the older person for more help. You think an activity could be done more easily another way. You think the older persons skills have changed. You are worried about the older person.

You think that there may be a risk of the older person hurting themselves. This is not a limited list and should you have any concerns at all ensure you should talk with your supervisor.

APPLY UNDERSTANDING OF CHANGES ASSOCIATED WITH AGEING ................................................................................................


TAKE INTO ACCOUNT PHYSICAL CHANGES ASSOCIATED WITH AGEING WHEN DELIVERING SERVICES Common health problems associated with ageing
Health Problem Arthritis and other musculoskeletal problems Information Two types of arthritis: Osteoarthritis (OA) Osteoarthritis is the deterioration of the joints that becomes more common with age. The knees and hands are most often affected, with pain and stiffness ranging from mild to severe. It can generally result as a lack of calcium and/ or vitamin D in the diet. Symptoms The symptoms of osteoarthritis are variable. Some people get only mild pain and stiffness; in others the symptoms are severe and disabling. Pain. This is the earliest symptom and is usually worsened by use of the joint(s) and relieved by rest. Pain from osteoarthritis of the hip is often felt in the groin or the front of the thigh to the knee. In osteoarthritis of the spine there may be pain and stiffness in the neck or lower back, and what is known as 'referred pain' down the arm or leg due to irritation of the nerves supplying the area. Stiffness following any period of inactivity. This tends to go away after using the joint(s) for five to 15 minutes. Swelling and redness of the joint(s) may sometimes occur. Weakness of the muscles around affected joints, sometimes giving rise to a feeling of joint instability. Reduced mobility from one or more of these symptoms.

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Health Problem

Information

Rheumatoid arthritis (RA) is an autoimmune disease that causes chronic inflammation of the joints. Rheumatoid arthritis can also cause inflammation of the tissue around the joints, as well as in other organs in the body. Autoimmune diseases are illnesses that occur when the body's tissues are mistakenly attacked by their own immune system. The immune system is a complex organization of cells and antibodies designed normally to "seek and destroy" invaders of the body, particularly infections. Patients with autoimmune diseases have antibodies in their blood that target their own body tissues, where they can be associated with inflammation. Symptoms The most common symptoms of rheumatoid arthritis include: Swelling, pain and heat in the joints. Stiffness in the joints, especially in the morning. Persistent fatigue. Sleeping difficulties because of the pain. Weak muscles.

Joints on both sides of the body are usually affected. Both of these problems lead to challenges with mobility and increased risk of falls. Depression Depression is a very common mental health issue. It should not be considered a normal part of ageing. It can be difficult to diagnosis in the older person as it can be confused as a symptom of other illness/ conditions. There are many risks associated with depression. More information can be found at the website: Beyond Blue www.beyondblue.org.au Diabetes is common in Australia. Diabetes is a condition where the body is unable to automatically regulate blood glucose levels, resulting in too much glucose (a sugar) in the blood. Food intake and blood sugar levels need to be monitored. Diabetes is a condition in which the level of glucose in the blood is elevated. Diabetes can cause damage to many parts of the body, resulting in heart attack, stroke, foot problems, impotence, kidney and eye damage. Treatments are available, but prevention is preferred. Insulin (made in the pancreas) allows glucose to enter the cells to be used as energy. Type 1 diabetes occurs when the body destroys its own insulin producing cells in the pancreas (an autoimmune response). The pancreas no longer makes insulin therefore glucose cannot enter the cells, so it stays in the bloodstream. The blood glucose level becomes too high and symptoms occur. Treatment for Type 1 diabetes involves multiple daily insulin injections together with healthy eating. Type 2 diabetes occurs when insulin does not work effectively (insulin resistance). Physical activity and healthy eating are necessary to keep blood glucose levels within normal. Tablets or insulin may be necessary if diabetes is not well controlled.

Diabetes

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Health Problem

Information Unless the blood glucose levels are very high, symptoms may not occur, so many people with Type 2 diabetes may not be aware they have diabetes. If symptoms occur, there may be thirst, tiredness and/or frequent urination. Some people experience other symptoms, such as blurred vision, thrush infection, and weight loss.

Frailty and deconditioning

Frailty is the state of being weak in health or body (especially from old age). Deconditioning is a complex process of physiological change following a period of inactivity, bed rest or sedentary lifestyle. It results in functional losses in such areas as mental status, degree of continence and ability to accomplish activities of daily living. It is frequently associated with hospitalization in the elderly. The most predictable effects of deconditioning are seen in the musculoskeletal system and include diminished muscle mass, decreases of muscle strength by two to five percent per day, muscle shortening, changes in periarticular and cartilaginous joint structure and marked loss of leg strength that seriously limit mobility. The decline in muscle mass and strength has been linked to falls, functional decline, increased frailty and immobility. Heart disease is a structural abnormality in the heart or the blood vessels that supply the heart. It can occur as a result of lifestyle choices and can lead to heart attack or stroke. There are a number of diseases that are result of this structural abnormality. Lung diseases range also in numerous types as a result of various factors. Some lung diseases are a result of smoking. People with heart or lung diseases may require a lot of assistance with all types of cares. The following are often common conditions: Congestive cardiac failure (CCF) Heart failure, is a disorder where the heart loses its ability to pump blood efficiently. The result is that the body doesn't get as much oxygen and nutrients as it needs leading to problems like fatigue and shortness of breath. Heart failure is almost always a chronic, long-term condition that is managed with medications and lifestyle changes. (Although it can sometimes develop suddenly.) Chronic obstructive airways disease or chronic obstructive pulmonary disease (COPD) Chronic obstructive airways disease or chronic obstructive pulmonary disease is a disease most often described as a combination of emphysema and chronic bronchitis. Emphysema refers to lung tissue dysfunction or damage which results in the person having to breathe in a more exaggerated fashion in order to get sufficient amounts of oxygen. Chronic bronchitis refers to inflammation of the bronchi in the lungs and is associated with excess mucus secretion and coughing, lasting months or years. Symptoms and characteristics of chronic obstructive pulmonary disease include: blue tinge to the skin due to lack of oxygen. breathlessness upon exertion eventually leading to constant breathlessness. coughing. excess mucus production due to chronic bronchitis. expansion of the ribcage due to expansion of the lungs. fatigue. susceptibility to chest infections.

Heart and lung disease

Incontinence

Incontinence is an inability to control the passing of urine and/ or faeces. There are many causes of incontinence and should not be considered normal for the ageing person. The four main categories are: Urge incontinence.

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Health Problem

Information Stress incontinence. Overflow incontinence. Functional incontinence. Many forms of incontinence can be treated and the older person who has issues of incontinence must be treated with dignity.

Neurological disorders

The most common neurological disorders in the older person are strokes and dementia although there are numerous neurological disorders. Stroke is a disease of the heart and circulation but it affects the brain causing damage to the surrounding brain and affects brain functioning. Dementia is a progressive degeneration of brain functions; depending on the specific disease results in different areas of the brain being affected. There are numerous skin disorders. As people age, skin becomes thinner and are prone to easier bruising, bumps, and skin tears. A simple knock can degenerate into a sore very quickly and take a long time to heal. Types of skin cancer There are three main types of skin cancer: basal cell carcinoma (BCC), squamous cell carcinoma (SCC) and melanoma. Skin cancers are named after the type of cell they develop in, and each type has different features. The two most common types of skin cancer are BCC and SCC. They are also known as non-melanoma skin cancers. Melanoma is the least common of the three, but the most serious. Basal cell carcinoma (BCC) BCC is the most common and least dangerous form of skin cancer. It is most common in people aged over 40 but can also develop in younger people.

Skin disorders including skin cancers

Features of BCC: slow growing. usually develops on the head, neck and upper body, but sometimes on arms and legs. looks like a lump or scaling area, which is red or pearly in colour. may ulcerate, bleeds easily and does not heal.

BCC doesn't usually spread to other parts of the body. However, if it isn't caught early, it may grow deeper into the skin and damage nearby tissue. This may make treatment more difficult and increase the chance of the skin cancer coming back. Squamous cell carcinoma (SCC) SCC often appears on parts of the body that are most exposed to the sun. It is most common in people aged over 50, but can develop in younger people. Features of SCC:
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grows quickly over several months. usually appears on the head, neck, hands and forearms and sometimes develops on the upper body or the legs. appears as a thickened red, scaly spots, which ulcerates or bleeds easily.
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can look like a sore that hasn't healed.

SCC is not as dangerous as melanoma, but can spread to other parts of the body if left untreated. An SCC on the lips and ears has a high risk of spreading, so if you have a spot on your lips or ears, see your GP immediately. Melanoma Skin disorders including skin cancers Melanoma is the least common but most dangerous form of skin cancer. It can be fatal if not detected and treated early. Features of melanoma: days. normally noticed over several weeks or months rather than

appears as a new spot, or an existing spot, freckle or mole that changes in size, shape or colour. may have an uneven or smudgy outline or surface, and be more than one colour (blotchy with brown, black, blue, red, white or light grey colour). may itch, bleed or becomes larger or irregular in shape. can grow anywhere on the body (even parts of the body rarely exposed to the sun).

If treated early, 95% of melanomas are cured. Nodular melanoma Nodular melanoma is a highly dangerous form of melanoma, because it grows more quickly in depth than other types of melanoma and can be life threatening if not detected and removed quickly. Features of nodular melanoma: grows quickly, in some cases becoming life threatening in 6-8 weeks. usually appears as a new small round lump on the skin, which may be black, brown, pink or red in colour. Other spots to watch for Dysplastic naevi are moles that have an irregular shape and have an uneven colour. People with many dysplastic naevi are more likely to develop melanoma. If you have these moles, you should regularly check for any changes and look for new spots on the skin. If you notice any changes, you should see your doctor immediately.

Solar keratoses (sunspots) usually occur in people aged over 40.

Features of solar keratoses: appear on the head, neck, arms and legs.

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Skin disorders including skin cancers

Stroke

usually flattish, scaly patches. may be pale or red, and may sting if scratched. may develop into squamous cell cancers. http://www.cancercouncil.com.au/editorial.asp?pageid=1315 Stroke is a disease that affects the arteries leading to and within the brain. A stroke occurs when a blood vessel that carries oxygen and nutrients to the brain is either blocked by a clot or bursts. When that happens, part of the brain cannot get the blood (and oxygen) it needs, so it starts to die. What Are the Types of Stroke? Stroke can be caused either by a clot obstructing the flow of blood to the brain (called an ischemic stroke) or by a blood vessel rupturing and preventing blood flow to the brain (called a hemorrhagic stroke). What Are the Effects of Stroke? The brain is an extremely complex organ that controls various body functions. If a stroke occurs and blood flow can't reach the region that controls a particular body function that part of the body won't work as it should. Vascular disease harms blood flow in arteries and veins throughout your body. It causes everything from leg pain to poor kidney function and stroke. Problems of the vascular system are common and can be very serious. Can be divided under six broad categories Aortic Disease: Affects the aorta, the largest artery in the body. The aorta delivers blood from the heart to the rest of the body. Arterial Disease: Affects the arteries, blood vessels that transport blood away from the heart to the rest of the body. Compression Disorders: Caused when blood vessels and nerves are constricted by other parts of the body. Venous and Related Diseases: Affect the veins, the blood vessels that transport blood from the arms and legs back to the heart. Sports-Related Vascular Disorders: Occur most frequently among high-performance athletes. Often caused by repetitive movement and heavy exercise. Aneurysms: Caused by weakness in a blood vessel wall that creates a significant bulge in a blood vessel. The bulge may harbor blood clots and may rupture, causing major blood loss or death.

Vascular disease

Practical activity Using the internet access the Better Health Channel website: www.betterhealth.vic.gov.au Look up the following terms. Take notes or print relevant pages to add to your resources. Research other common medical conditions that may affect the older person and add these also to your resources. Arthritis Stroke Incontinence Depression Osteoporosis Chronic obstructive airway disease COAD Congestive cardiac failure CCF Dementia

How physical changes affect person care services


It doesnt matter whether the older person is living in their own home or in an aged care facility or attend community programs people have different physical changes and require different levels of support.

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The following table show practical examples of how physical changes might affect personal care services.

Physical changes
A person with balance problems A person with dementia A person with troubles swallowing A person with Acquired Brain Injury (ABI)

Effects on personal care services


Assistance or help with transfers may be required. They may not be able to care for themselves at home any longer. Some can also have challenging behaviours. They need to be assessed and may require assistance to eat their meals to ensure they are safe. Potential Risk to care workers if the person becomes aggressive or angry.

Physical changes
A person with visual impairment A person with motor neurone disease

Effects on personal care services


They may no longer be able to care for themselves at home and longer. They require a high level of care towards the end of their life.

Care Plans
Each service provides an individual Care Plan for each person in care. This Care Plan is a document which clearly outlines such things as the persons individual problems and needs. This Care Plan should reflect a holistic approach to care. That is, t he physical, psychological, social and spiritual needs of the person should be covered by the care plan. There are expected outcomes and goals for each person, as well as actions or interventions agreed to by the other support staff. A principal aim of service provision is to assist the person to maintain as much independence as possible. Services are funded on a sliding scale which is directly related to the level of independence of the person. Ensure that you are familiar with the types of aids and other supports that are available for the older person. Read care plans before attending to a resident/ client to ensure you are aware of the support/ care that is required. SIMPLE EXAMPLE OF A CARE PLAN Blueberry Home and Community Care Care plan Personal Details Surname: Jackson Given Name: Jack Preferred Name: DOB: 13.10.1945 Address: Unit 3/ 145 Court St, Stanley Phone: 07 1234 5678 Doctor: Jane Smith Allergies: Nil Known Aids Used Glasses - Reading Dentures Upper - yes Lower - yes Walking Stick - yes

Physical condition: Jack has arthritis in his right hand and needs supervision/ assistance to carry out everyday tasks. Tasks: Grooming and Dressing: Supervise appropriate use of clothes, Jack dresses inappropriate wears pyjamas when going out. Check clothes and bedclothes for staining. Hygiene Assistance: Assist/ supervise or shower on Monday, Wednesday, Friday am. Washing hair once a week and other times as requested by client. Observe abilities.

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Meals: Jack has meals on wheels delivered three (3) days a week Monday, Wednesday, Friday. Ensure meals are being eaten. Monitor/ ensure there is food in the cupboards, fridge. Mobility: Regularly observe Jacks mobility. Social Activities: Attends community day centre twice a week (2) Tuesday and Thursday. Laundry: Washing done once a week and hung on the line Jack is able to bring the washing inside. Jacks neighbour does his ironing when required. Cleaning: Jack is able to do basic cleaning wiping benches, sweeping the floor and vacuum when required. Cleaning of house is done once a fortnight. Areas to be done: rooms to be vacuumed and or swept. bathroom and toilet cleaned. kitchen clean and floor mopped. Medication: Jack uses Webster pack for his medication and does not require assistance to take medication. Signature: Mary Jane Ford Supervisor Care Plan review: Date: Outcome:

Progress notes
The term given for recording information about a resident or client may vary with organisations. These records are referred to often as either progress notes or care notes. Check to ensure you are familiar with the correct term used in your workplace for recording changes of the resident/ client. Any physical changes must be reported to your supervisor, a registered nurse or manager who can follow up and make appropriate adjustments to the persons care plan. Also ensure that you have recorded these details using the appropriate documentation of the workplace. It is not just physical changes that need to be reported. Any changes or concerns must be reported to your supervisor, a registered nurse or manager who can then follow up the concerns or issues. Information must be factual and objective.

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The following is an example of a care note EXAMPLE OF CARE NOTE Care Note Blueberry Home and Community Care Surname: Jackson Given Name: Jack Address: Unit 3/ 145 Court St, Stanley Phone: 07 1234 5678 Service: Date Of Birth: 13.10.1945

Home care Personal care X Home maintenance Transport

Note: Jack was observed limping this morning before having a shower, holding onto the furniture, even while using his walking stick. When helping Jack with his shower at 0900hrs I observed that his right lower leg was red and looked swollen and I noticed a broken skin area near his ankle. I asked Jack if his leg was hurting and he stated oh its hurt a bit for a couple of day s Asked what had happen; he said couldnt remember. I contacted the supervisor after Jacks shower and advised of his condition. Date: 21.9. 2009 Signature: M. George Mary Li George Personal Carer

Looking after you


When working with the older person you need to ensure that you look after your own health and safety. Often the older person will require assistance to do a number of things such as getting out of a chair, getting out of bed. In your supporting them to do various things you need to have been shown the best ways to help the older person. You need to look after yourself as well as the older person.

APPLY KNOWLEDGE OF COMMON PROBLEMS ASSOCIATED WITH AGEING WHEN DELIVERING SERVICES
There are a lot of problems linked to ageing, from hearing and vision problems to problems just paying the bills. As an aged care worker, you need to understand common ageing problems. The older person may find it difficult to talk about problems or how they feel emotionally. You may need to enlist the help of family, friends, carers, your supervisor or other health professionals. You can find out information by reading the persons care plans. Alternatively, talk to co-workers who also work with the older person. Pay attention to the older person when you are attending to cares and activities with the older person and ask questions about the help they need. Take notice of when a task is becoming difficult and offer more support, ensure you inform your supervisor of this. Your workplace will have a procedure for reporting a residents/ clients changing needs. You can report in a number of ways, these can include: phone, written form, email, face to face. The following table outlines some common ageing problems in broad categories and some examples of how these affect the older person. Emotional Become overly dependent on others Become upset easily Resist the need for help Lose informal support of neighbours and friends Lose support of family members Forget who they are Think they have completed a task when it hasnt be done e.g. showering, dressing Not remember why or how they need help Become lost easily when they are out Forget what they are doing or why they were doing something Not care for themselves Be lonely or isolated Sleep to much or too little

Cognitive

Social

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Medical

Eat, drink alcohol or smoke more than they should Not interact with others socially Be depressed Be incontinent Have restricted movements Have difficulties swallowing (Dysphagia) Have trouble with movement, balance or coordination Become confused Complex or multi medical conditions

Ongoing learning
Many workplaces offer training to staff members. There are many types of training courses offered which you can do to increase you knowledge and skills relating to aged care. There may be new information or new ways to do things. We all need to keep on learning as part of our jobs. You may be asked to fill out a training plan. This is often part of your employee annual review or performance appraisal. A training plan will assist you to continue building skills and knowledge.

ASSIST THE OLDER PERSON TO RECOGNISE THE IMPACT THAT CHANGES ASSOCIATED WITH AGEING MAY HAVE ON THEIR ACTIVITIES OF LIVING
Many changes occur as a result of ageing which can affect the way the older person manages their ADLs. The following table outlines some common ageing problems in broad categories and some examples of how as an aged care worker you might need to help the older person who is experiencing difficulties Emotional Encouragement to visit friends Specialist help e.g. counselling To be observed closely for signs of depression Tasks broken down into smaller steps Assistance to find things Reassurance if they become distressed about memory problems Reminder to take medication, to eat or drink Information be given more than once You to explain who you are and why you are there Encouragement to engage socially with others A social worker or other health professional To be linked in with activity groups in the community To talk to a doctor Close monitoring and observation Food to be vitamised Aids or equipment Extra time to assist with tasks

Cognitive

Social

Medical

Role of services
Aged care services assist the older person to access and manage their own abilities to perform ADLs. Provide assistance for the older person to understand the impacts that ageing and its associated health issues have. Services collect information via formal assessments Aged Care Assessment Team, observation and/ or discussions with the older person, family and/ or their advocates. This information is then used to create a broader picture about how the older person is managing and shared between relevant stakeholders. Assessments take many forms and happen in different ways. Assessments are often performed by different therapists at different times to avoid tiring or upsetting the older person.

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The older person needs to be part of the assessment process. They need to understand how the process will assist them. Aged care workers also help with assessments by observing an older person, explaining something to them and/ or providing additional information in forms or checklists. Encourage the older person to say when they are having difficulties with their ADLs. They may want to talk to someone or yourself about these issues. The older person may require a new assessment to be done. Minor changes can make a difference to how an older person can maintain their independence. A therapist may be able to suggest changes to how things are done or a piece of equipment that can help the older person. There are also times when the aged care worker needs to talk to their supervisor about an older person and their ADLs, particularly if you: Are worried about the older person. Think there is a risk of the older person hurting themselves. Think that an activity can be done more easily in a different way. Are asked by the older person for help doing things they normally do for themselves.

COMMUNICATE SITUATIONS OF RISK OR POTENTIAL RISK ASSOCIATED WITH AGEING TO THE OLDER PERSON What are the risks or potential risks to an older person?
Risk is a situation which has the potential to create a hazard to a persons health, safety, or well -being. Risks that occur may be physiological, psychological, emotional or environmental. Risks are found in all environments. However, the amount of actual risk to an older person will vary, depending on the particular environment and on the number of personnel and checks in place to monitor and minimise risk.

Types of risks
Self neglect. Dysphagia. Infection. Falls. Uncharacteristic or inappropriate behaviours. Impaired judgment and problem-solving abilities. Injury. Sudden or unexpected changes. Cognitive impairment due to acquired brain injury (ABI) or dementia. Environmental hazards. Social rights infringements.

Self-Neglect
The older person living by themselves in their own home may be at risk from self neglect, especially in those situations where there is no immediate family member supporting them. Loneliness and self-neglect may be made worse by the onset of early stages of dementia and consequently the likelihood of risks and dangers are multiplied. It means that the older person is not looking after themselves. There may be signs the older person is: not eating or drinking adequately. neglecting their personal hygiene. not taking prescribed medication. not using aids and equipment that are recommended e.g. not using their walking stick.

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Dysphagia
Dysphagia means trouble swallowing. It means that the person may have difficulty with swallowing food and drink. They may cough, choke or food may enter the trachea and end up in the lungs instead of passing through the oesophagus. This can cause abscess or pneumonia. They may also be at risk of malnutrition or dehydration if food and drink do not reach the stomach. Malnutrition is when the body is damaged because its not getting enough nutrients to work properly. Dehydration results if someone does not take in enough fluids. It causes dizziness, headaches, cramps and a loss of consciousness. This condition can occur in the older person with diseases such as stroke, multiple sclerosis (MS) or motor neurone disease (MND). In some forms of Dementia this can also happen.

Infection
As a person ages, they often become less mobile and their body functions may be affected. At the same time, the possibility of medical conditions such as heart disease, diabetes, or dementia increases. For some people, problems of incontinence may lead to urinary tract infections. Other areas of concern for infections are the aged persons feet and legs. The older person may no longer be able to attend to their own feet and legs. Corns, calluses, bunions and ingrown toenails can become potential infection risks. Regular attention to foot hygiene by podiatrists can minimise these risks. Skin tears on the legs and feet can also have serious consequences. Thin, fragile skin combined with poor peripheral circulation contribute to a high risk of even the smallest skin tear developing into a long term problem because of infection and a further reduction in mobility. Providing padding by bandaging the legs may reduce the risk of skin tears, but bandaged legs are not generally visually attractive so many susceptible aged persons choose to accept the risk rather than wear the preventative padding. Leggings are designed specifically to protect the legs (physio stocks these).

Falls
There are many factors that contribute to the very high risk of falls. These include: Poor sight and hearing. Decreased mobility and agility. Many prescribed medications have side effects such as light-headedness and fluctuating blood pressure. Existing medical condition, e.g. high or low blood pressure, epilepsy, severe osteoporosis (many falls are believed to be the result of spontaneous fracture of the hip. i.e. the severely weakened hip bone breaks, perhaps because of something as simple as a sneeze, and this causes the person to fall). Non-compliance with advice to use mobility aids, e.g. walking stick or an inappropriate use of mobility aids. Uncharacteristic or inappropriate behaviours As an aged care worker, should you notice an older person behaving in an uncharacteristic way or inappropriately, it can be a sign that something is wrong. They may have an infection or be dehydrated. The behaviour could be the result of a mental illness or brain injury. The older person is not often aware of the risks associated with this behaviour. Impaired judgment and problem-solving abilities When an older person is having trouble making decisions or making poor decisions, it can be a sign of conditions such as stroke, brain injury, dementia or infection. It can also be due to depression or anxiety or the side effects of medication or drinking too much alcohol. Impaired judgment is when the person does not assess or judge situations correctly. They may think the situation is safe when it is not. Injuries Poor sight and hearing may contribute to the person s inability to recognise defects in electrical and other household appliances. Despite advice to the contrary, many will insist on using the appliances even though you consider that it constitutes a risk to them. It is still their choice to use the appliance providing that it does
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not put others at risk but it is within the duty of care for you to tactfully point out the potential risk of using faulty implements/appliances. It may, in some cases, be appropriate to inform the older persons family of th e risk involved after consultation with the older person. If there is some doubt about the older persons ability to understand the risk, you should talk with your supervisor about informing the older persons family. The older person may have difficulty learning how to use modern gadgets, as they are often called. In some cases, trying to come to terms with the new equipment is often quite frightening. This is so with many people but more particularly in the case of the aged. It is a persons right to continue to make choices about their own safety. In cases where the older person has chosen to take the risk it is sometimes a policy of the workplace that the older person signs a form to say they have made that choice. This relieves the worker of their responsibility and demonstrates that the worker has followed the procedure of informing the aged person about the risk. Cognitive impairment due to acquired brain injury (ABI) or dementia Acquired brain injury can cause the person to engage in risky behaviour without a full understanding of the risks. Many people with an ABI or dementia show poor judgment or situations. They make decisions without thinking because they dont understand the effects of their behaviour or actions. They may not think clearly or logically. The change of behaviour can be sudden or may show odd behaviour, appear very sleepy, be distressed, fall or stumble or repeat things they have already been told. This needs to be reported to the doctor and/ or your supervisor straightaway. If the situation is serious or you are worried then you may need to call an ambulance. Environmental hazards Environmental hazards can include: slippery or uneven floors. poor lighting. poor security. bars on windows. steps or stairs. uneven pathways or driveways. poor house or room layout. toilet doors that open inwards. physical obstructions; e.g. furniture and equipment. old electrical items or bar heaters. heating and cooling devices that do not work properly for the area. doors that are hard to open.

Risks should be pointed out to the older person, their advocate or family members. Any hazard or risk must be reported to your supervisor and recorded in the persons care plan and notes.

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The following table outlines some hazards aged care workers should look out for: Uneven surfaces outside Uneven surfaces indoors Frayed electrical cords report problems to the supervisor who may arrange for maintenance to fix problems. relocate any small objects/ items causing the problem. suggest other pathways to take where possible. report problems to the supervisor who may arrange for maintenance to fix problems. relocate any small objects/ items causing the problem. inform the older person of the hazard. report the problem to the older person. report the problem to the supervisor. request a replacement item. do not use the item. report the problem to the older person. report problems to the supervisor who may arrange for maintenance to fix problems.

Other issues Poor lighting

Social rights infringements


Everyone has rights that are part of living in society. Infringing someones rights means stopping them from doing the things that they have the right to do. An example is stopping an older person from leaving their home.

Why is it important for you to identify potential risks to the aged person?
Understanding what constitutes a risk situation requires an awareness of the potential risks outlined above. It also requires constant observation of any changes in the situation as you carry out your daily care of the aged person. For you to do this adequately you should find out what is in the care plan for the individual, establish what should be the norm, and then report observed activities or events that are abnormal. Knowledge of the ageing process and its attendant problems will be crucial to your level of understanding and your ability to identify potential risks. Age-related changes may include changes to body, health, social well-being, and environment.

Among other things the aged person may experience:


Continence difficulties. Mobility problems. Medical conditions, such as diabetes. Loss of concentration. Confusion. Hearing impairment. Visual impairment. Short term memory loss. Grief as a result of loss of a partner, family pet, member of the extended family or independence. Change in their familiar environment, such as moving from the family home to a hostel. For example: Consider the following situations: You arrive at Mrs Duvalls house and find her sitting in the kitchen surrounded by a weeks supply of meals provided by Meals on Wheels. The care plan indicates that Mrs. Duvall has confusion and has a poor appetite. She also has diabetes and is at risk of falling into a diabetic coma if she does not eat regularly. The situation needs to be reported immediately to appropriate personnel and assistance sought. In this situation, it is important to recognise Mrs. Duvalls circumstances, her diabetes, and the implications if she does not eat regularly. Identification of potential risks to the older person will be enhanced by your ability to respond to it.
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When encountering a potential risk situation, one where you believe the safety, health or wellbeing of an older person is in jeopardy, you need to be aware and do whatever is reasonable to ensure that the older person does not suffer foreseeable injury or harm. The best guide in deciding whether any injury is serious enough to require necessary precautions or action being taken is to consider the precaution that those in the general community might use under similar circumstances. It is generally advisable for you to seek some advice from a supervisor about any concerns you may have about an older persons welfare, no matter how small. Assessing risk must be done as far as possible from the point of view of the older person, rather than that of the worker. This is referred to as objective observation.

Objective observation
It is not easy to be objective. It requires you to put aside your personal values, attitudes and beliefs and to avoid placing personal interpretations on the situation or individual you are observing.

A few rules to follow may include:


Always double check the observation to ensure that what is observed warrants intervention. Always check the observation to make sure that the situation presents a potential risk. Talk with the aged person respectfully about your observation so you can get more information. Where the aged person cannot communicate with you, ask a relative or co-worker about the individuals normal behaviour.

Effective techniques
In situations of identified risk you should: Follow workplace procedures. Seek advice.

Following workplace procedures:


Procedures will differ from one workplace to another. You need to seek out and be familiar with your own workplace procedures for responding to health and safety risks. These procedures will outline the immediate and appropriate action to take in situations of identified risk. You need to understand how and why it is necessary to perform certain tasks in a particular way. Understanding procedures rather than just following orders will enable you to respond appropriately in a situation of risk. Seeking advice Seek advice should be the motto for all workers. You should consult another person when an issue presents a problem or when you are uncertain. Seeking advice also assists your professional development as you gain valuable information for yourself. You should seek out work place lists of health professionals and other relevant personnel who can assist the person in care. These lists should identify: The person/s to be contacted in an emergency situation. The nature of their position. Their previous association with the aged person.

Such personnel could include: Doctors. Nursing staff. Community nurses. Community health staff. Physiotherapists. Occupational therapists.
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Clergy. Local Chemists. Senior aged care facility staff. Emergency service staff e.g. ambulance. Occupational health and safety officers or representatives.

What are effective ways to explain to an aged person that they are at risk?
Before explaining a risk or potential risk to an aged care person you need to consider a number of issues.

These include:
The duty of care to inform an aged person of risk. The aged persons ability to hear and understand. Whether advice or consultation with a supervisor or colleague is necessary. The persons right to choose to take informed risks.

The workers responsibility to the aged person and the care plan. Explaining any risk to the aged care person requires tact and care. You must do it clearly and in a way that respects their dignity and does not alarm them.

For example:
You should position yourself in front of the person, making eye contact (if culturally appropriate) and avoiding an overbearing attitude.

If they are sitting, sit so you are both on the same level
If you have been working with the older person you will have built a relationship over a period of time and it will be easier to communicate with them. In situations where there has been little or no previous contact, the task becomes much more difficult and complex. The ability to use tact and care takes some practice and you may not feel confident initially to perform the task comfortably. In these situations, you should seek assistance and advice. There are some important factors to remember when talking to an older person about potential risk. They include: Having an empathic approach. Respecting their dignity. Using clear language. Maintain eye contact (if culturally appropriate). Being aware of their cultural background. Note: there is more information about communication skills in the Additional Notes and Glossary.

How can you report and document identified risks in the workplace?
Documenting information about risks and potential risks is important for maintaining the maximum independence and safety of the aged person. Objective observation should be the basis of documentation. This means that the worker observes and records it exactly, not what they think or feel about a situation. Each workplace should have its own procedures for reporting and recording potential risks. These will differ from one workplace to another, but all should identify what workers need to report and to whom. The worker needs to know why a procedure is necessary rather than just following orders. As a worker, you should know: Where to locate the appropriate forms/documents used to report any situation or event. How to report, based on your own concerns, no matter how trivial these may seem. How to report, either verbally or in writing.

The workplace guidelines for reporting and recording.

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SUPPORT THE RIGHTS AND INTERESTS OF THE OLDER PERSON ...............................................................................................


ENCOURAGE AND SUPPORT THE OLDER PERSON AND/OR THEIR ADVOCATE/S TO BE AWARE OF THEIR RIGHTS AND RESPONSIBILITIES
Support rights, interest and needs of the aged person. Charter of Residents' Rights and Responsibilities
The User Rights Principles 1997 made under the Aged Care Act 1997 (Cth) includes a Charter of Residents' Rights and Responsibilities. The Charter details the rights and responsibilities of all residents including personal, civil, legal and consumer rights. The Charter also outlines residents' responsibilities in relation to other residents, staff and the residential aged care service community as a whole.

Note: Below the term residential care service means the same as aged care home. Each resident of a residential care service has the right:
To full and effective use of his or her personal, civil, legal and consumer rights. To quality care which is appropriate to his or her needs. To full information about his or her own state of health and about available treatments. To be treated with dignity and respect, and to live without exploitation, abuse or neglect. To live without discrimination or victimisation, and without being obliged to feel grateful to those providing his or her care and accommodation. To personal privacy. To live in a safe, secure and homelike environment, and to move freely both within and outside the residential care service without undue restriction. To be treated and accepted as an individual, and to have his or her individual preferences taken into account and treated with respect. To continue his or her cultural and religious practices and to retain the language of his or her choice, without discrimination. To select and maintain social and personal relationships with any other person without fear, criticism or restriction. To freedom of speech. To maintain his or her personal independence, which includes a recognition of personal responsibility for his or her own actions and choices, even though some actions may involve an element of risk which the resident has the right to accept, and that should then not be used to prevent or restrict those actions. To maintain control over, and to continue making decisions about, the personal aspects of his or her daily life, financial affairs and possessions. To be involved in the activities, associations and friendships of his or her choice, both within and outside the residential care service. To have access to services and activities which are available generally in the community. To be consulted on, and to choose to have input into, decisions about the living arrangements of the residential care service. To have access to information about his or her rights, care, accommod ation, information which relates to him or her personally. To complain and to take action to resolve disputes. To have access to advocates and other avenues of redress. To be free from reprisal, or a well-founded fear of reprisal, in any form for taking action to enforce his or her rights.

and any other

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Each resident of a residential care service has the responsibility:


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 which is 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 his or her current state of health. Everyone in society has rights. There are legal obligations attached to many right such as access rights for people with disabilities or the rights to services, health care and education. The older person also has rights.

WHAT SERVICES ARE AVAILABLE TO ASSIST AGED PERSONS TO ADDRESS THEIR NEEDS AND RIGHTS?
Advocacy Services
There are some people who cannot articulate their needs because they: have communication difficulties both verbal and written. have problems understanding what they are being asked because of health problems such as stroke or dementia, which may affect their thinking, memory or understanding. would prefer someone else to speak for them. There are free and confidential Advocacy Services in each state and territory. These services assist people who want someone, on their behalf, to talk to their aged care service provider. Advocacy services can also help people understand their rights. For further information, contact: National Aged Care Advocacy Line on 1800 700 600 An advocate can also be a family member, a close friend, or a lawyer appointed by the state government. Advocates ensure the older persons rights are protected. There are also international guidelines and Commonwealth and state legislation that you need to know about. United Nations principles for the older person Australia is a member of the United Nations (UN) and as such accepts the obligations outlined in its charter. In 1991 the United Nations developed the United Nations principles for older people. These are outlined in the following table.

Independence

Access to: food, water, shelter, clothing and health care. education. a safe environment. The opportunity to: earn an income and to decide the age they will stop working. stay at home as long as possible. The opportunity to: participate in society and policies that affect them directly. serve the community as volunteers. form movements and associations of older people. Access to: family and community care and protection. health care to maintain physical, mental and emotional wellbeing. social and legal services. appropriate levels of institutional care. The opportunity to enjoy human rights and fundamental freedom.
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Participation

Care

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Self-fulfilment Dignity

The right to pursue opportunities for the full development of their potential. Access to educational, cultural, spiritual and recreational resources of society. The right to: live in dignity and security. be free of exploitation and physical/ mental abuse. be treated fairly regardless of age, gender, race, ethnicity, disability, financial status.

These rights can be found at www.un.org/ageing/un_principle.html

Australian laws and guidelines


The following table outlines the relevant guidelines and Australian laws that you should be aware of as an aged care worker.

Aged Care Act 1997 (Cth) Privacy Act 1988 (Cth)

Outlines how aged care services should be provided, and the rules and standards for aged care. Explains how personal information should be collected, shared, protected, stored and destroyed.

Department of Health and Ageings Sets out standards of care. Includes a charter of residents rights Residential care manual (2009) and responsibilities, which explains the rights and responsibilities of residents living in aged care facilities (see below for the charter). Home and community care (HACC) guideline HACC statement of rights and responsibilities Workplace policies and procedures There are seven goals for providing HACC services. Some states in Australia have a statement of rights and responsibilities for all people using HACC services. You need to know if this applies in your workplace. All aged care workplaces have rights and responsibilities. You need to have access to your workplace policies and procedures so you are aware of these. Talk to your supervisor if unsure.

There are many kinds of rights. You need to be aware of the main areas where older people and their advocates have rights so you can support them to maintain their rights. Older people have the following rights: 1. Privacy and confidentiality. 2. Dignity. 3. Freedom of association. 4. Informed choice. 5. Complaints. 6. Freedom of speech. 7. Standard of care.

What is confidentiality and privacy and how does the carer maintain it?
The following is the standard which addresses the mandatory compliance for residential aged care facilities in respect to privacy and confidentiality for persons/residents/clients. This is the minimum standard which is expected by the Department of Health and Ageing in regard to a person/resident/client.

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Privacy and Dignity Expected Outcome


Each resident's right to privacy, dignity and confidentiality is recognised and respected.

Preamble
This expected outcome addresses the issues of a resident's right to be treated with dignity and privacy and that information regarding their care and personal details is kept confidential. Respecting each persons right to dignity and privacy enhances professional relationships between residents and staff.

Considerations
Staff awareness and procedures that support residents to maintain personal relationships and carry out personal activities in private. Regular review of residents' ability to carry out personal activities in private. Procedures to support residents' right to die with dignity. Resident care plan identifies the resident's wishes in respect of cultural, religious and other aspects of their terminal care. Procedures to ensure each resident's or their representative's wishes are respected after death, including ensuring that all members of the health care team are informed of these wishes. Procedures for securely storing residents' records and personal information. Staff and the health care team aware of, and comply with, confidentiality procedures. Residents are addressed according to their wishes. Fostering professional relationships between staff and residents and their families or their representatives.

Confidentiality and privacy


Confidentiality is not only a right of the person/resident/client but should be one of the first considerations when you begin work in the aged care sector - persons/residents/clients must feel as though their privacy and confidentiality are addressed to feel safe. This is the basis on which positive and pro-active relationships are built. Person/resident/client confidence is often broken, not as a result of purposeful chatter, but is a result of unthinking behaviour, an error in judgment rather than an error in intent. However, the result for the person/resident/client is the same and not acceptable. All care workers need to relieve their stress levels by talking about their workday and in some cases their most difficult or time consuming people/residents/clients. The most likely person they will speak to is their family or friends. This is not always a bad thing but remember: Do not use names or specific details. Be very careful about where you are when you have these conversations as they may be over heard.

Below is an extract of the Aged Care Act 1997 relating to privacy and confidentiality of clients
Division 62- What are the responsibilities relating to protection of personal information?

62-2 Responsibilities relating to protection of personal information The responsibilities relating to protection of personal information, relating to a person to whom the approved provider provides aged care, are as follows: c) the personal information must not be used other than: iii. for purpose connected with the provision of aged care to the person by the approved provider, or iv. for a purpose for which the personal information was given by or on behalf of the person to the approved provider;
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d)

except with the written consent of the person, the personal information must not be disclosed to any other person other than: iv. for a purpose connected with the provision of aged care to the person by the approved provider; or v. for a purpose connected with the provision of aged care to the person by another approved provider. vi. for a purpose for which the personal information was given by or on behalf of the person; c) the personal information must be protected by security safeguards that are reasonable in the circumstances to take against the loss or misuse of the information. Where privacy and confidentiality is maintained and the client is secure in that knowledge, you will more than likely have created an environment where the client and/or his/her advocate will be comfortable, and feel able to tell you of his/her individual needs and wants. The ability to speak up is empowering for the client. And most importantly: Only use this stress relief as a last resort. If you feel as though the job is becoming too much for you then talk with your supervisor or registered nurse before you become overwhelmed.

Freedom of association
The older person has the freedom to associate or meet with and talk to anyone they choose. No one has the right to stop the older person from seeing people they want to see.

Informed choice
The older person has the right to make informed choices about everyday things. They also have the right to choose where they would like to live and how they would like to be cared for and if they want medical treatment. As aged care workers you need to explain choices available to the older person. Your workplace will have policies and procedures related to ensuring older people can make informed choices.

Complaints
Everyone has the right to make a complaint. As an aged care worker you need to know how older people and advocates at your workplace can make complaints. Assist them to complete forms if required as well as provide information or refer them to your supervisor if you are unsure.

Complaint Resolution Scheme


All Australian Government-funded residential aged care homes are required to establish their own internal complaints handling mechanism. Although using a homes complaints process may generally be the most effective way to resolve a complaint; residents, their relatives or representatives, can also contact the Aged Care Complaints Resolution Scheme. The Scheme focuses on resolving complaints by working with those involved to find solutions. The Scheme: Is free and accessible. Assists residents to clarify concerns and expectations and to make effective complaints. Can deal with confidential or anonymous complaints.

Freedom of speech
Older people have the right to express their ideas and views. As an aged care worker your job is to give good quality care in a caring and friendly way to older people even if you do not agree with their views.

Standard of care
Aged care services will have information about their standard of care; the older person may need to sign a document agreeing to the standard of care they will receive. Although they have the right to expect that the care they receive will always meet or exceed the agreed standard.

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Community Visitors
The Community Visitors Scheme aims to improve the quality of life of residents of aged care homes by facilitating one-on-one relationships with volunteers who have similar cultural backgrounds and/or interests. Staff at residential aged care services can assist in putting residents in contact with a visitor from their local Community Visitors Scheme.

CONDUCT WORK THAT DEMONSTRATES A COMMITMENT TO ACCESS AND EQUITY PRINCIPLES


Access and Equity
Access and equity principles support the view of equal rights, specifically the right to access and the right to have an equal share of whatever is on offer. Minority groups should not be disadvantaged in this respect. Access and equity principles are applied broadly across many societal sectors, one example being the Government and the issuing of funds to states and territories. Older people living in care facilities or receiving aged care services have the right to access all the things that other humans have such as: Medical or other health care. Information to assist in making decisions. Control over their finances. A right to refuse treatment. An advocate to assist as necessary.

As aged care workers, you can help by adopting a client-based approach when caring for the older person. It means ensuring that the service meets the need of the older person. The service should adapt to meet the need of the older persons needs not the older person having to make changes. Aged care services need to meet the cultural needs of both culturally and linguistically diverse (CALD) and Aboriginal or Torres Strait Islander (ATSI) people. They can do this by: asking people form CALD and ATSI backgrounds what they think of the service. learning about the culture and languages in their local areas. ensuring brochures are available in languages besides English. promote services through ethnic and cultural groups. Aged care workers can help by: understanding people have different needs. seek feedback from the people who use the services. understand cultures of older people who use the services. access interpreting services for older people who may need them.

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ADOPT STRATEGIES TO EMPOWER THE OLDER PERSON AND/OR THEIR ADVOCATE/S IN REGARD TO THEIR SERVICE REQUIREMENTS
Care Plans
A care plan is a guide that assists the aged care worker in knowing what care and assistance is needed for a resident/ client. The plan is specifically designed to meet the residents/ clients needs and is individualised. Care plans explain: the goals for the support being given. what the older person wants to achieve. how, when and where the support will be given. the older persons preferences. The care plan is developed in consultation with the older person, their advocate if applicable, and their family. These plans help the older person control their own service needs and ensure workers understand these needs. An older persons care plan may be changed to: meet changing needs of the older person. include new preferences. include requests by a case manager or health professional. resolve problems with care. react to a regular review process.

Aged care services must also identify if they are unable to meet an older persons needs. They shou ld then refer the older person to another service and help them make the contact.

Information strategies
Information can be provided in many ways. This information needs to be easily understood by the older person or their advocate. Some of the ways in which information can be provided: explaining the information in person. answering questions. ask questions to ensure the information has been understood. printing brochures in other languages. print in larger print. provide CD, DVD, tapes of the information. using an interpreter. re-write the information so it is easier to understand. provide information more than once.

Helping the older person stay in control


Services need to ensure that the older person and/ or their advocates have understood the information and the choices that are available to them. Choice can include such things as: services for the home like getting assistance with cleaning. where to live. getting respite care. Also of importance is the older person or their advocate need to be aware of costs, the services provided and their responsibilities. The older person should never be pressured by the service to take particular types of support. It is extremely important that the older person or their advocate understand what their choices mean.

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PROVIDE INFORMATION TO THE OLDER PERSON AND/OR THEIR ADVOCATE/S TO FACILITATE CHOICE IN THEIR DECISION-MAKING
In some workplaces, giving information is part of your dreams. Make sure you are aware of the rules about giving information to the older person or their advocate. The way in which you give information is also very important; for if you give too much at once you will only confuse the older person. Providing information can be given to the older person by: talking to them about their needs. tell them about services you know about. write down the names and phone number of services for them. give them brochures or printed information about the service. phone services for them - you must have permission from your supervisor and the older person and/ or their advocate before doing this.

The following table may be of assistance to help with support and information: Service Commonwealth Carelink Centre Description Contact details

A regional information and referral service. www.commcarelink.health.gov.au Provides lots of information about community phone 1800 052 222 and residential support services in regions all over Australia. Provides information and support about www.centrelink.gov.au welfare, pensions, allowances and phone retirement services employment. 13 2300 All local councils have an aged care section Call the council and ask for the aged care that can help with support for older people section living in the community. This service provides assessments of older Ask your supervisor peoples care and support needs. They give advice and information to the older person and their family or advocate. They make referrals to services for the older person. Older people must have an ACAT assessment in order to get support through some case management programs. They also need an ACAT assessment to use residential care. Provides information, support and emergency www.health.gov.au assistance to unpaid carers (family members phone 1800 052 222 or friends) of older people. They also support people with disabilities and their carers. There emergencies is a centre in every region of Australia. 1800 059 059

Centrelink

Local council

Aged care assessment teams (ACAT)

Commonwealth Carer Respite Centre

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RECOGNISE AND REPORT TO AN APPROPRIATE PERSON WHEN AN OLDER PERSONS RIGHTS ARE NOT BEING UPHELD
Aged care workers are often the ones who notice when an older persons rights are not being protected because they are in direct contact with them. You are able to see when things change or if the older person is sad or upset. This can be a clue to something not being right. Watch for changes and listen to the older person. Asking questions and be willing to fix problems. In doing this you will notice when something is wrong. If you do not have time to talk about a problem, make sure you report it to your supervisor, do not ignore the problem. Sometimes older peoples rights are not upheld; examples of these are: They may not have been given all the information they needed to make choices about their lives. They could have refused support for a number of reasons such as their culture, religion or sexual preferences. Their personal information may have been given out without permission. Their support may have been withdrawn because of a complaint they made. They may have had personal care attended with their door wide open to the public passing by. If older persons rights are not being upheld, its part of your job role to report this. Who you report this to will depend upon the seriousness of the situation. The following table outlines some options: Why Who to report to They may: Team members be able to give you advice about what to do next. have experienced a similar problem. be able to talk to your supervisor with you. They may be able to: Your supervisor deal with the problem themselves. refer the problem to someone who can help. They may: Senior management be able to help or refer to someone who can help. have links with other organisations that can help. liaise with your supervisor. They may: Carer and/ or family member. be able to provide more information. Always have permission from your know when something is upsetting the older person. supervisor first They may be able to help the older person if the problem is to Health workers do with their health care or treatment. e.g. doctor, nurse, counsellor. Always have permission from your supervisor first They can help if: The police the breach of the older persons rights is against the law. Emergency 000 The person is in danger of harm or injury. Local police station for non-urgent issues They can help if you have a complaint or concern about the The Aged Care Complaints government-funded aged care service. Investigation Scheme These groups: State-based elder rights provide advice about rights and responsibilities. advocacies assist with complaints. provide information and education sessions to aged care recipients, their families and staff of aged care service providers. promote community awareness of the rights of the older person. Maintaining privacy and protecting confidentially is extremely important when discussing any issues of the older person. You need to have permission from the older person to do so. There are times when the older person does not want anyone to know about a problem with their rights.
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They may be embarrassed or ashamed and not want to worry anyone else. You need to be able to discuss the older persons problems with your supervisor or other management without revealing the older persons details. You need to know how to report any problems with an older persons rights. Your workplace will ha ve policies and procedures that you will need to follow when reporting a problems or check with your supervisor. There are two main reasons why information needs to be reported by care workers: Many community service facilities receive government funding that is directly linked to the type of service and level of care that is provided. If the care services provided are not accurately and regularly recorded, funding may be reduced or withdrawn. In order to ensure the continuity of care, reporting must be accurately carried out. If care workers always accurately record relevant information into the persons notes and care plans, it is easy for their co-workers and other members of the health care team to provide appropriate support to them. This is due to their having ready access to all of the necessary information regarding the type of support or assistance that has already occurred, what is currently in process and what may be required in the future.

Verbal reports
During the course of your work you may be required to verbally report events or issues, either face-to-face or over the telephone. It is important when reporting verbally to have all of the information prepared and in order and to report the facts of the issue accurately and clearly to ensure that the person you are reporting to can fully understand the situation. The report that you give will affect the person/client and therefore you should practice the skills of reporting accurately and objectively. Remember when using verbal communication to report an issue, it is important to: Be objective and report what actually happened. Speak clearly and avoid rushing. Make sure that you are fully understood and that there is no room for misunderstandings. Clarify anything that is not understood and report the incident or issue as soon as possible to ensure that your recollection is clear and accurate. Report an incident in a logical sequence of events, that is, what occurred prior to the incident, during the incident and following the incident regardless of whether it was a change in the behaviour, appearance or mood. Avoid being critical or judgmental or the person/client as this will impact negatively on the listener. Be aware of your body language and facial expressions when you are reporting in a face-to-face situation.

In emergency situations you may be required to verbally report the situation of the person in your care/your client to an ambulance officer or a medical practitioner, either over the telephone or face-to-face. It is important that you: Provide your name and title. Provide the name of the person/client. Provide the address and phone number of your location. Clearly state the problem and objectively explain exactly what happened. Clearly state the condition of the person/client. Provide the telephone number of the persons/your clients general practitioner if required. Provide information about, or the telephone number of, your organisation or the person/clients next of kin if required.

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You may be required to verbally report any relevant information to colleagues during end of shift handovers in addition to the completed notes for your shift. Reporting in person means that you have to personally be present to do the reporting. Such as - you have a case meeting about an older person where you meet with a number of workers and professionals together. Reporting in writing this can take many forms. It means that things are written down and recorded. Communication books are used to share information with family members or carers They may: report minor problems. ask questions of family members / carers. document observations. record tasks performed for family member/ cares.

Remember the importance of using only objective language for accurate reporting. What to report
The types of issues that carers should report include: Anything about the person/client that does not appear to be normal. Changes in person /clients behaviour, e.g. people/clients behaving in an unusual or different manner. Changes to a persons/clients daily routine which are significant enough to cause concern. Significant changes to personal care. Changes in person/clients emotional state, e.g. person/client appearing anxious or upset about an issue. Increased changes to a person /clients ph ysical or mental condition e.g. reduced mobility, increased physical discomfort, sudden memory loss, personality or cognitive functioning. The person/client making unusual changes to their environment or in relation to their physical belongings. Complaints from a person/client. Procedures undertaken by a person/client, e.g.: doctor or dental appointments. Developments of any skin conditions. Irregularities in dietary management. Difficulties with continence management. Any adverse effects of prescribed medication. Situations of risk or potential risk of the health and safety of people/clients and care workers. Changes in financial status. Changes to person/client support networks e.g.: loss of friends or relatives, inability to participate in the community, social or recreational groups. Any information that a carer believes may be relevant or useful to other members of the care team.

It is important that care workers record all of these issues or changes in the person /clients care plan, and that any changes, which are considered significant, are immediately reported in order for the appropriate action to be taken.

Who to report to
Your organisations policies and procedures will provide guidelines that will inform you of the people to whom you may need to report any significant changes in your people/clients.

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The people you may need to report will include: Your supervisor your supervisor is the most important person you need to report information back to and must be kept informed, at all times, of any significant changes in the appearance or behaviour of the people in your care to ensure that the appropriate action can be taken. Once you have reported any changes to your supervisor, they will direct you on any other action that may need to be taken by you or another member of the health care team. Colleagues and other care workers any change in behaviour or appearance of people in your care must be documented in the care plan to ensure that information is available to other care workers who need to know. Information sharing can assist care worker to fulfil the persons needs. Health workers and medical practitioners it is important to report any changes in a persons condition which is related to a medical issue to other health workers involved in the persons care, and to the persons medical practitioner. Because they are also responsible for the health and safety of the person, it is vital that they have access to any relevant information that may affect that persons health and well -being. Health care services and other health professionals it is important to report relevant information to organisations or individual care workers from outside of your organisation who are assisting people with a particular problem, e.g. podiatrists, dentists, occupational therapists. In such cases, you will need to be aware of your organisations policies and procedures related to reporting information to people outside of your organisation and of issues of client confidentiality. Community Care information related to changes in a persons behaviour or appearance might need to be reported to organisations that provide community care to the person to enable them to provide effective assistance and to make any necessary adaptations to services they are providing. Emergency services emergency service needs to be contacted immediately if you consider the change in a persons condition or behaviour to be critical and requiring immediate medical attention, e.g. heart attack, stroke or severe injury. Administrators some people/clients may have administrators responsible for their health and well-being or responsible for other matters e.g. financial issues. In order for administrators to effectively perform their duties, any changes related to these areas may need to be reported directly to them so that they can respond accordingly. Social services some situations may require you to consult social services to report significant changes in the behaviour or appearance of a person e.g. situations of abuse, matters of security. Relatives or next of kin there are some situations, which require you to legally inform concerns related to behaviour or appearance of a person to the next of kin, or close family members e.g. increased aggressive behaviour or depression. A relative may be able to counsel the person/client or assist care workers with strategies that may help to address the persons/clients problem or situation. Care workers who are working in home-based or residential aged or community care facilities will have an appointed supervisor to whom they can report information in keeping with their organisations policies and procedures. However, it is important that care workers are aware of the processes involved in reporting information in situations where a supervisor is not available. All organisations involved in providing care services, including those that are independent of the aged care banner, will have policies and procedures which detail guidelines for reporting information. It is the responsibility of the care worker to know and understand the processes for reporting information that they must follow. Independent care practitioners should know where to go and to whom, for extra assistance to ensure that they can provide quality services to the people in their care and, in the event that they are unable to provide a particular service, they should be able to refer people/clients to the appropriate organisation. Each workplace will have its preferred style of the way for communicating information. A good written report should have: your full name. your place of work. the date and time of the issue/ problem. the date and time the report was made. the action you took. the action taken by anyone else.
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details of what happened or what the issue/ problem are. the facts rather than just your ideas, view or thoughts.

PROVIDE SERVICES REGARDLESS OF DIVERSITY OF RACE OR CULTURAL, SPIRITUAL, OR SEXUAL PREFERENCES


Aged care services must provide support to a variety of people with different views and from different backgrounds, races, religion and cultures. Talk to your supervisor should you have any problems or issues be it with residents/ clients or yourself. The standard of care must be the same regardless of differences.

Community Visitors - is one way of providing services.


The Community Visitors Scheme aims to improve the quality of life of residents of aged care homes by facilitating one-on-one relationships with volunteers who have similar cultural backgrounds and/or interests. Staff at residential aged care services can assist in putting residents in contact with a visitor from their local Community Visitors Scheme.

Diverse relationships people live in different types of relationships.


As carers, you need to supply the same care standards to the older person regardless of whether they are in a heterosexual or homosexual relationship. There are laws in Australia that protect peoples rights to ensure people are treated equally. Age Discrimination Act 2006 (Cth) Aims to: Racial Discrimination 1975 (Cth) Act Sexual Discrimination 1984 (Cth) stop discrimination based on age. protect everyones legal rights regardless of their age. help others understand that everyone has the same rights. remove barriers that stop older people from joining in work activities and being part of society. remove stereotypes and false beliefs about older people. promote equality before the law for everyone, regardless of their race, colour or ethnic origin. make discrimination against people on the basis of their race, colour, descent or national or ethnic origin unlawful. prevent discrimination based on gender or marital status. prevent sexual harassment.

Aims to:

Aims to: Act

PROVIDE INFORMATION TO THE OLDER PERSON AND/OR THEIR ADVOCATE/S REGARDING MECHANISMS FOR LODGING COMPLAINTSMANAGING COMPLAINTS
At times, the residents/ clients or their advocates may not feel that their rights are being upheld. When this occurs, the client may want to complain about the service. Part of your role is to assist them to do that. Aged Care workplaces, although not looking forward to receiving complaints, will tend to use the opportunity to improve the service instead of feeling upset or angry with the client. The client has the right to complain and should be encouraged to do so. He or she must also be given access to an advocate of their choosing if applicable. Complaints are a part of the work you will do, so part of your role is to know and understand your organisations mechanism for complaint management. All aged care services, both residential and community based, will have documented complaints management systems in place. You will need to find out what that mechanism is, and also what documentation is required to be completed, within your organisation. It is preferable to work with the older person and/ or the advocate to resolve the issue. Assist them if necessary to complete a complaint form or
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similar document. You may even raise the issue on their behalf, depending on the nature of the complaint and the complaints mechanism within your workplace. Unfortunately, this is not always going to happen, and you must support the older persons wishes if they seek action outside the workplace. They may need to be referred to outside bodies such as the Department of Health and Ageing Complaints Resolution Scheme. REMEMBER - Complaints may be the result of clients who: Do not understand their rights. May not know that there is legislation to protect them. May not know what it means. May not be able to read the information. May not be able to process the information was provided to them.

May not have had sufficient information provided to them. You have a responsibility to recognise this, and if dealt with appropriately and swiftly, unnecessary complaints may be avoided.

EMPOWERMENT OF THE OLDER PERSON AND/OR THEIR ADVOCATE


Professionals in aged care services, in either the community or residential environment, are ethically and legally obliged to ensure that the older persons are not denied their rights. They also have an obligation to support older people not only to understand, but also to obtain their rights. This comes through empowerment of the older person and/or his/her advocate. Empowerment often results from broadening the knowledge base of people in care and/ or the knowledge base of those supporting that person. Providing people with adequate information is one way of doing this. The legislation provides steps to ensure that potential care recipients and their families receive full and correct information in relation to: All aspects of care. Residents agreements. Security of tenure in facilities. Complaint resolution. Advocacy services. Full information regarding services available.

Charter of Rights. The rights, as set down in the legislation for older people, are no different from the rights of other human beings. We all look forward to being able to make full and effective use of our rights: To be treated with respect and dignity. No discrimination or victimisation.

When we work in a community or residential service, we will work hard to assist clients to cope with many personal issues. The one which seems to affect them most is fear of losing control over their lives. When people lose some of their independence or the ability to self-care, this change in their lives requires them to be assisted with the things they used to be able to do for themselves. This can lead to a lot of frustration! With emotions flowing and anxiety levels high, what are my rights and what does this really mean would not be questions foremost in their minds. Therefore, care workers have the ongoing responsibility to be honest and respond to the needs of the older person. You will need to know and understand what the older persons rights are, where the information is written, how the rights are explained, and who the formal and informal people are who can assist. To ensure the older persons individual needs can be met, carers must first establish a relationship of trust with the older person. Where an older person feels secure and has faith in the person or people delivering
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the care or service, they are more likely to speak up about their needs. This can be assisted by the carer constantly reminding the client that they have the right to speak up.

IDENTIFY INDICATORS OF ELDER ABUSE AND RESPOND APPROPRIATELY IN LINE WITH ORGANISATION GUIDELINES
Elder Abuse
Elder abuse is a single or repeated act, occurring within any relationship where there is an expectation of trust, which causes harm or distress to an older person. Abuse can include physical, sexual, financial, and psychological abuse and/or neglect. Signs of elder abuse could include apart from obvious signs of physical abuse: Fear of a particular person or people. Worried and anxious for no obvious reason. Irritable and overly emotional. Appearing helpless, hopeless and sad. Using contradictory statements - not as a result of mental confusion. Reluctant to talk openly. Avoiding physical, eye or verbal contact.

It is important to note that as a carer you play a vital role in the prevention of elder abuse by knowing how to recognise it and what to do if you suspect it.

Elder Abuse and the Law Mandatory Reporting Guidelines for Aged Care Providers
Amendments to the Aged Care Act 1997 were designed to increase safeguards for residents of Aged Care homes. The Act requires approved Aged Care providers to report physical and sexual assault on a resident of an Australian Government subsidised Aged Care home. From 1 July 2007, Aged Care providers must have systems and protocols in place that enable compulsory reporting of such incidents. If the approved provider receives an allegation of, or starts to suspect on reasonable grounds that unreasonable use of force or unlawful sexual conduct on a resident has taken place, they must report the allegation or suspicion as soon as reasonably practicable and within 24 hours. They must also provide protections for staff who report abuse.

Ref: www.agedcareaustralia.gov.au/internet/agedcare/publishing.nsf/Content/help+with+health
Some Issues
Elder Abuse is a relatively recent term for a form of mistreatment that, in reality, is just one part of a spectrum of violence that occurs when differences in power exist in relationships between people. Simply put, where there is an imbalance of power in a relationship, there is a risk of abuse occurring from the dominant person or persons. These power differences have been interpreted, particularly in relation to domestic violence, as the result of living in a patriarchal (or male orientated society) where males and male values dominate. This type of gendered analysis of power and violence can easily be justified by noting that, in all age groups, the majority of those being abused are female while the abusers are mainly male. However, this gendered view of violence and abuse becomes blurred somewhat when the abuse occurs in older populations. Even though there are more women than men in older populations, older women are still more likely to be abused than older men. A major 1998 incidence study found that overall a disproportionate number of older women were victims of abuse compared to men, although older men were more likely to be victims of abandonment. Women also represented nearly half (47.5%) of the perpetrators of abuse in this NCEA study while adult sons and daughters combined to create the single biggest category of abusers. This would suggest that there are more factors than gender at work in elder abuse situations.

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Other than gender, age discrimination - or 'Ageism' - is a factor that should be considered when discussing abuse in older populations. Certainly, in western societies there appears to be a general negative attitude towards ageing and older people, a manifestation of which is the often-patronising stereotypes of older people portrayed by the media. These attitudes create a fertile ground for age discrimination and, like any form of discrimination, it devalues and disempowers the group it is directed against. The existing discrimination faced by minority groups also compounds the effects of ageism. Other factors such as language barriers, access to culturally appropriate services, lack of a support infrastructure within some community groups, and so on, make detecting and responding appropriately to abuse in these communities a major challenge. Rural and remote communities within Queensland present another set of challenges associated with distance, availability and access to services, and the understated issue of maintaining confidentiality within small community groups. Because our bodies are dependent on the fluid and nutrients we consume every day to maintain us at an acceptable functioning level in everything we do, good nutrition is absolutely essential for elderly people. Unfortunately, there are many factors which prevent elderly people from maintaining adequate nutritional levels. Such factors include: Poor oral or dental hygiene. Medications, which creates loss of appetite. Illnesses, such as a virus or gastric problem which make it difficult to eat. Dementia, which may lead to forgetting to eat. Depression, which may lead to lack of motivation to eat. Loneliness, which may lead to loss of appetite. Isolation which may lead to loss of confidence and motivation to eat. Religious or cultural beliefs which may prevent the consumption of certain foods and restrict an aged persons diet.

Financial constraints. Those aged people living by themselves in their own home may be at risk from self neglect, especially in those situations where there is no immediate family member supporting them. Loneliness and self-neglect may be made worse by the onset of early stages of dementia and consequently the likelihood of risks and dangers are multiplied.

The risk of physical abuse


Physical abuse may take place in the aged persons home and incidents of this are sometimes reported in the media. Aged people are often defenceless in situations of violent attack, even when reasonable precautions have been taken to protect them. However, advice about simple procedures can improve the security of the home and the person within it. For example - the installation of safety chains and panic buttons may increase safety. The aged person could be advised on simple self-defence strategies, as well as on the safekeeping of valuables. There is also an increased risk of physical abuse on elderly residents of aged care facilities by other confused residents. Studies have shown that residents of facilities have great fear of unprovoked attacks, usually verbal abuse, by fellow residents. Staff must be vigilant to ensure that confused residents, themselves frightened by events and environments that are strange and sometimes threatening, do not lash out at other residents whom they perceive to be intruders in their homes.

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SUPPORT THE OLDER PERSON WHO IS EXPERIENCING LOSS AND GRIEF ...............................................................................................
RECOGNISE SIGNS THAT OLDER PERSON IS EXPERIENCING GRIEF AND REPORT TO APPROPRIATE PERSON
For older people, a major issue for grief and loss is the compounded emotional experience brought on by multiple losses. A person may experience the loss of a spouse, a number of friends, their own independent living, children moving away - all within a relatively short period of time such as one or two years. Some people can experience a type of grief overload. This can lead to depression and withdrawal. Losses experienced by the older person can be summarised under the following headings: 1. Social loss e.g. loss of status following retirement; loss of driving license; loss of social networks. 2. Physical loss e.g. disabilities or limitations in physical functioning; loss of mobility; loss of health. 3. Psychological loss e.g. loss of physical attractiveness; loss of independence; loss of control; memory loss; loss of self-esteem; loss of personal possessions; loss of significant others. Reactions to loss that a person may have could be a wide range of feelings and behaviours that may include: Shock Shock is just not a surprise or fright Symptoms may include: Physical distress Panic pale, cool, clammy skin. thirst. rapid, shallow breathing. rapid / weak pulse. nausea and/ or vomiting. collapsing and unconsciousness. progressive shutdown of the bodys vital functions . chest pains. sleeplessness or insomnia. difficulty in sitting still or concentrating. loss of appetite. upset stomach.

Symptoms such as:

The person feels they have no control, confused or unable to express their emotions. Physical symptoms may include: breathlessness. Sweating. Shaking. chest pain.

Emotional release

This can happen when first hearing of the loss and throughout the stages of grieving. Uncontrolled emotional outburst is called hysteria. Symptoms may include: crying. screaming. anger. uncontrolled laughter.

Negative behaviours such as hostility to others or

This is often related to the stages of anger and depression. If they feel extreme anger, they can become hostile. If they feel depressed then they may feel they do not care what happens to them. They

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destructive behaviour Lack of interest/apathy

could even show signs of self-destructive behaviour. This may also relate to the depression stage, they feel apathy. They stop seeing people, take no part in any activity or even leave the home. They may perform routine hygiene.

In 1969, Kubler-Ross identified five stages that a person may go through when they are dealing with loss and grief. She did this after closely studying people who were dying. This is not exclusive just to the terminally ill, but also other people who are affected by bad news, such as experiencing a loss. The important factor is not that the change is good or bad, but that they perceive it as a significantly negative event.

Denial

Anger

Bargaining

Depression

Acceptance

The stages are: 1. Denial. This is when the person finds it difficult to believe that something terrible is happening to them. The person instantly says No in their mind. Kubler -Ross says this is a good thing to happen as it initially protects the person from having to confront the painful truth. 2. Anger. The person may feel anger towards themselves, their carers, their doctor, God etc as they come to realise that the situation is not going away. 3. Bargaining. In an attempt to push back the inevitable, the person tries to bargain in the hope of gaining time. They may for example say If I stop smoking now, I will... 4. Depression. When the person sees that bargaining is not helping, they may slip into depression as they try to accept reality. 5. Acceptance. The person stops protesting and fighting the inevitable and comes to a peaceful acceptance of their fate. It is important to note that while these stages appear neat and clear, people will move backwards and forwards between the stages or may even come to a stage and never progress further. For example, you have probably heard of the expression, He/she died very angry. At other times , the person may appear to be in several stages at the same time; they may for example be depressed but still want to bargain with God, the doctor, the health care team etc. Another theory on Grief (McKissocks theory on grief) recognises the individuality of a persons grief. The theory states there is no set way to grieve, as many factors will affect the grief process. Everyone will approach grief and loss as an individual depending upon his/her life experience, current family situation, previous reactions to change, religious and personal beliefs and the nature of the loss to him/her personally. There will also be differences because of the different cultures from which we come. For example, it is inappropriate for Aboriginal people to refer to someone who has died by their name. The process of grieving is therefore different for everyone and it is important that carers accept this and do not try to control it. The grieving process can take a long time. How often have you heard of someone saying to another person Its been a long time now since died. Its time you snapped out of it!

Widowhood
An older persons coping strategies are developed over years of dealing with lifes stresses, but some situations have a profound effect on their emotional state. One such situation is widowhood. The experience of losing a long-term partner varies from one individual to another. Older people have usually had some exposure to death through losing friends or other family members, but the loss of a spouse is often the most difficult to deal with. Elderly women are widowed at a higher rate than men.

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Loss of work
For many people paid employment has been the most important aspect of their lives. The loss of paid employment usually means a large reduction in income. Men frequently define themselves in terms of their work and their friends tend to be work colleagues. Due to retirement, many men lose their network of work colleagues and they become reliant on their partner for social activities. Consequently, the health of older men tends to decline with widowhood. Many older people live in poverty and have very few if any family or social contact. Superannuation and wise financial planning were unheard of many years ago. In some cases people become very depressed and their health, lifestyle and fitness declines, their nutritional intake is very poor resulting in failure to thrive and a condition characterised by malnutrition, weight loss and depression.

Loss of family structure


For many people it can be very sad when children grow up, leave home and choose their own paths in life. For others it is a beginning of new opportunities and freedom to pursue new interests. Many older Australians experience the loss of not only their adult children who may have moved to towns and cities far away, they also mourn the loss of grandchildren and the celebration of their small achievements in life.

Loss of health
Growing older does not have to mean always being ill, but unfortunately the risk of illness, frailty or disability does increase with age. It is important to remember recovery from illness may take a little longer for an older person and they will need your support and encouragement during this time. It is important that you have access to information about the help that is available to them so they can take as much control as possible of the choice of services available to them.

Loss of friends and colleagues


The older we become the more likely we are to lose friends and colleagues with whom we shared valued activities. Although they cannot be replaced, we can enjoy the company of other people by joining some of the many organisations which are available. Older age can be a time of new growth and new friendships for people who are willing to look for these opportunities.

USE APPROPRIATE COMMUNICATION STRATEGIES WHEN OLDER PERSON IS EXPRESSING THEIR FEARS AND OTHER EMOTIONS ASSOCIATED WITH LOSS AND GRIEF
Some principles for helping the bereaved are listed below.

Stay away from platitudes


God sends crosses to those he loves Its Gods will Hes happy and at peace now

Listen and listen some more


Grieving people need to tell their story over and over until it can be put into perspective. Just listen

and let them recognise their feelings of loss. Dont push


Do not set expectations for where someone must be with their grief. One of the biggest needs of grieving people is relief from the expectations of others.

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Consistency
Consistent presence and availability over the long haul is best. It is not helpful to smother or be around constantly. Remember the worst times are anniversary, birthday, date of death. Send a note, visit or call.

Be willing to reveal your own feelings


If you knew the deceased, share your feelings and memories.

Knowing what normal grieving is


Be familiar with normal grief feelings, thoughts, behaviours and physical sensations such as hollowness in the stomach, tightness in chest/throat, dry mouth, lack of energy, breathlessness, sighing. Some people worry that they are becoming permanently disorientated. Unless it is very intense and goes on for a long time, it is normal grieving.

Help to actualise the loss


When appropriate mention the dead persons name, allow the venting and rehearsal of all the feeling associated with the loss.

Accept feelings of anger and/or guilt without judgment.


Anger makes many of us uncomfortable. Affirm its expression when it occurs. Guilt is a way of coming to terms with a relationship that has ended. Dont try to take it away from the griever. To balance the persons perspective it might be helpful to mention the positive things the grieving person did do. Excessive guilt is unhealthy and not normal.

Help the bereaved to adjust to life without the other.


Dont allow dependence. Do encourage the grieving person to bide their time before making decisions to change their lives, e.g. moving, new relationships. Encourage some activity or outside commitment to balance the pain of grief after the initial period of shock has passed.

In time, encourage new relationships and involvements.


While the bereavement process can often take 3-5 years, there comes a time when the griever feels and acts ready to begin new relationships and get involved in new activities. Let them take the lead but support it.

PROVIDE OLDER PERSON AND/OR THEIR SUPPORT NETWORK WITH INFORMATION REGARDING RELEVANT SUPPORT SERVICES AS REQUIRED
Understanding individual differences
People suffer grief and loss differently. Trying to understand what their feelings are, you can offer them the right kind of support. Examples: If they are grieving due to the loss of a loved one, the right place to refer them might be a loss and grief association. They could also be helped by their church or a support group for people who have lost a loved one. If they have a disease, there may be an association or support group for that disease that may be the right place to refer them. If the person is grieving because they are losing their sight, an occupational therapist might be the right person to refer them to. Alternatively, there may be a vision loss support group who can help. providing information of support network services to assist their specific grieving. You need to take into account the older persons needs when planning support to help them cope with loss and grief. Talk with your supervisor and follow your workplace policies and procedures .

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DELIVER SERVICES WITHIN A QUALITY FRAMEWORK ................................................................................................


IDENTIFY KEY ASPECTS OF THE QUALITY FRAMEWORK AND HOW THEY LINK TOGETHER
Aged care services are delivered within a quality framework and aged care providers utilise the quality cycle to ensure they are achieving ongoing continuous improvement. Continuous improvement is a belief or philosophy based on working to make things better. It suggests that while things may already be good, we can always strive for better. Under the aged care legislation, all facilities must practice continuous improvement - it's about working in partnership with everyone involved. A quality improvement cycle (commonly referred to as Continuous Improvement) is a planned sequence of systematic and documented activities aimed at improving a process. A typical quality framework considers: safety everyone receiving care is kept safe. effectiveness people receiving care are helped by the care. appropriateness the right care is provided. acceptability those receiving care are consulted about their care. access all eligible people have the ability to receive quality services.

efficiency resources used provide value for money for services. Other aspects include: best practice the best possible way. organisational values what the organisation consider to be important. codes of conduct staff must behave in a way that reflects the organisations values . continuous quality improvement continuous striving to be better. client-centred approach everything in the organisation revolves around the client.

induction and regular training all staff have up-to-date knowledge. Improvements can be effected in two ways: 1. By improving the process itself and/or 2. By improving the outcomes of the process. A quality improvement cycle/Continuous Improvement can typically be defined into the four steps of Plan, Do, Check and Act. 1. Plan the change. 2. Do implement the change. 3. Check monitor and review the change. 4. Act revise and plan how to use any learnings.

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Plan

Act

Processes

Do

Check

Demonstrating evidence of a well-established quality improvement cycle is necessary for aged care providers to obtain accreditation and receive ongoing commonwealth funding.

DEMONSTRATE UNDERSTANDING OF REGULATORY/ ACCREDITATION QUALITY STANDARDS IN RELATION TO DELIVERY OF SERVICES


What is accreditation? Accreditation is about ensuring residential aged care homes meet a set of quality standards relating to the care provided to residents. These are set by the Australian Government. All residential aged care homes must be accredited in order to receive funding from the Australian Government through residential care subsidies. Currently, there is no official accreditation requirement for community care. The Carers role in accreditation and quality improvement Everyone has a role in continuous improvement. Carers can be involved by: Learning the aged care standards. All aged care providers have information on the standards and their recent accreditation reports. Making suggestions for improvements. Helping with implementing improvements. Completing staff satisfaction surveys when available. Attending a quality assurance meeting or joining the quality assurance committee. Attending general staff meetings. Undertaking internal audits. Maintaining effective documentation.

Managing complaints and concerns promptly. www.accreditation.org.au The standards reflect the quality management and services expected of a residential aged care service. The standards do not provide a recipe for satisfying expectations but, rather, opportunities to pursue quality in ways that best suit the characteristics of each individual aged care service and the needs of its residents. The standards are structured as an integrated matrix and no standard can be considered in isolation from the others.

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This pursuit of quality will necessarily involve self-assessment by each organisation of all aspects of its operations to enable it to plan and implement strategies for improvement. This cycle must be continuous and standards quality audits will look for evidence that it is occurring. It will not be expected that all services should respond to a standard in the same way. The objective of a Standards Quality Audit is to check that a service has systems in place, that those systems are being implemented, and that they do in fact sustain quality outcomes in the service's particular circumstances. Assessment against each standard therefore focuses on the range of activities that a service's policies and practices provide in support of the standard. The outcome of an assessment is based on service management and staff demonstrating the policies and practices it has implemented, and of their effectiveness in supporting the standards. The standards require that residential care services be staffed with appropriately skilled and qualified people sufficient to ensure that services are delivered in accordance with these standards. The standards do not set out the skills and qualifications required to perform different duties, rather, the appropriate response to a resident's needs will always be dictated by those particular needs. The critical issue is that they are effectively met and it is with this that the standards are necessarily concerned. A number of key references are made to the need for assessment when determining how to meet residents' needs. While these specific references are useful signposts, all of a resident's needs and preferences with respect to issues that affect resident life should be subject to an integrated assessment contributed to by all members of the health care team in partnership with each resident or his or her representative. Finally, it is important to note that the order of the standards does not reflect their relative importance. All of the standards are regarded as necessary parts of the framework for quality, and all criteria clarify, but do not limit, the range of activity that may be pursued in support of a standard.

Purpose
The standards for residential aged care services were developed in partnership with all stakeholders. Residential aged care services are assessed against these standards to determine their suitability for accreditation. Accreditation is recognition which rewards the effort involved in implementing and maintaining a quality service. The levels of accreditation indicate a service's performance as assessed against the standards. An accredited service is one which has its quality system recognised and supported through an on-going program of independent assessment and quality audit. This recognition provides evidence that an independent assessment of the service has occurred and that it meets defined performance standards which are based on outcomes for residents. Quality systems are the service's structure, policies, procedures, resources and activities that together ensure the capability of the service to meet the quality requirements of its residents. Quality systems are the management tools used to achieve agreed outcomes and which enable a service to demonstrate that standards are being met in relation to each aspect of service delivery. Assessment for accreditation requires service management to provide evidence to demonstrate that their system works to deliver effective outcomes. Quality management within each service is the foundation which underpins the system. Quality and continuous quality improvement are management and staff responsibilities in each service. This involves the careful management of every aspect of service at every level within the organisation. The standards provide a structured approach to the management of quality. They represent clear statements of expected performance and provide criteria to evaluate how well a service is performing and to identify gaps or opportunities for improvement. The standards apply equally to all residents in a service.

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An understanding of the standards by which residential care facilities are held accountable is valuable information for the newly qualified assistant in nursing. It is these standards which dictate the standard of care delivered and the quality of the working environment. Compliance with these standards also ensures ongoing training and in-service education for the staff, along with currency of skill and knowledge base. Implementation of standards in aged care has brought with it consistency of care and accountability for providers - both of which only serve to enhance the standard of care and elevate the status of the industry.

ENSURE WORK PRACTICES REFLECT THE ORGANISATIONS POLICIES AND PROCEDURES


The organisation that you work for is governed by industry standards and by its own particular guidelines and policies. This is applicable whether the organisation is providing community, home-based care, residential care or a combination of care options. Each organisation develops a set of policies and procedures in accordance with industry standards. Industry standards are specific goals or outcomes that have been established to maintain the safety goals or outcomes that have been established to maintain the safety of employees and to ensure that client service delivery is of the highest standard possible. Industry standards also allow for service provision to be continually monitored or improved upon wherever necessary. It is important for care workers to understand the importance of organisational standards and it is essential for care workers to familiarise themselves with those standards, policies and procedures for their employing organisation. Services should be provided to people/residents/clients in accordance with those standards at all times. All aged care workers need to be aware of the policies and procedures in their workplaces. Organisational standards, policies and procedures are developed and implemented in the workplace for many good reasons including to: Working safely and correctly. Working ethically. Knowing employee and employer responsibilities. Maintaining the rights of residents/ clients. Dealing with cultural diversity. Responding to breaches of laws or guidelines. Comply with legislative requirements. Ensure continued government funding or private sponsorship. Address specific incidents. Ensure accountability and quality of services. Provide the maximum level of assistance to people/clients within the available resources of the organisation.

When you commence your job, the policies and procedures of the workplace will be explained to you. You need to know where the written policies and procedures are kept and how you can access them. Your supervisor can assist you to access and understand these documents. You may find that some organisations have very strict guidelines whilst others are more flexible in their approach towards the provision of services to people/clients. However, in setting their own standards related to the quality of service provision, organisations must abide by the legislative rules laid down.

Workplace policies
Most workplaces have policies. Policies tell you how work is done and why things are done in a certain way. They give you guidance and tell your how your employer and supervisor expect you to work. Policies guide you in how to do your work and help you make decisions about the right things to do. They are there to give you protection in difficult situations.

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Examples: workplace health and safety. privacy and confidentiality. manual handling and lifting. using your own vehicle. providing transport. handling money.

Workplace procedures
Most workplaces have procedures for doing many tasks. Procedures explain the steps to take to complete tasks. They may be simple lists of instructions that are used every day. They may tell you how to act in a situation. Policies and procedures are often closely linked. Thus, the policy and procedure need to be read together. Example: the workplace health and safety policy might refer to the procedure for reporting an accident. Examples of procedures include how to: making a bed. disposing of sharps. report a hazard. file information. use equipment. use a work car. apply for petty cash. using the correct form care plan, hazard identification, complaints, leave form.

Roles and responsibilities in the workplace Your job description or position description will be given to your when you apply for your job, or when you start work. You need to refer to your job description and the duties that are described in it. You need to be fully aware of the duties that make up your particular role in the workplace and your duties as part of the work groups or teams. Key parts of your job may include the following areas: provide direct personal care to residents/ clients. participate in assessment processes of residents/ clients. provide emotional support to residents/ clients. maintain privacy and dignity of residents/ clients. enable residents/ clients to maintain maximum independence. work as a member of the health care team. ensure health and safety in the workplace. maintain good clinical recording.

Roles, expectations and status will vary to some extent between workplaces. Sometimes you may be asked to do things that are not part of your duties. If you do them, you are working outside your job role or scope of practice. You may need to check with your supervisor or look up a policy or procedure. It is better to ask questions and make sure you are doing the right thing. If you should find out the task is not something you should be doing, you need to explain this to the person. Be polite but firm. Be clear about what you can do to help. There are always good reasons for not doing certain tasks. This is usually related to the task being unsafe or not within the scope of duties. Always check with your supervisor, manager or Registered Nurse if you are unsure of what to do.

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COMPLETE DOCUMENTATION THAT FEEDS INTO THE QUALITY SYSTEM


Documentation in the aged care and community care sectors
This comprises the official agency record of the proposed services and service provided. A recipient of residential care or community support services has his/her care recorded in a personal or clinical file. All staff will need to be familiar with the type of language used in these files. Clinical documentation should reflect the client/residents health care status, changing needs and care or support given. The clinical file is a working document and is an essential tool for ensuring both continuity of care and legal adequacy. It must be accessible to all authorised care staff. It provides: A record of individual needs (dynamic and flexible). A plan for effective ongoing care. Historical and ongoing account of the care or services provided recording what is done, why and how. A communication tool between nursing or care staff, management, treating doctors and paramedical personnel, e.g. physiotherapists, divisional therapists, occupational therapists. A legal document to provide evidence of care or support. An action plan for continuing services.

The clinical file may be used for: Validation of care for government funding or legal purposes. Auditing purposes, e.g. Nurse Manager or Standards Monitoring Department. Research and education. Staff instruction, i.e. duties and responsibilities.

In view of the above, accuracy is essential in documenting the clinical file to support: The possible legal use of the document. Ongoing provision of services that meet the needs of the individual resident/client. Maintenance of appropriately planned continuing services. Valid ongoing evaluation of care or support.

When recording anything in resident/client records, objective language should be used in order to eliminate generalisations, interpretations, bias or judgments. That is, you record what you saw, heard, felt (by touch) or did, rather than using subjective language that infers, concludes, supposes or assumes. For Example: Mrs. Smith was crying on her return to residential care from a day visit to her home. She said that her car had died during the previous week. It appears that Mrs. Smith has suffered some sort of personal tragedy today, and I dont think that she will ever cope with living in the facility again.

See the difference? The first is an accurate and objective account of Mrs. Smiths distress the second is an assumption or conclusion about what she is experiencing. Descriptive documentation accurately records: Severity, onset and location e.g.: pain, when appeared, area of. Frequency and duration, e.g. how often, how long. Precipitating or aggravating facts, e.g.: what you were doing at the time.

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Associated symptoms, e.g.; swelling, redness and bruising. Colour, quality and consistency, e.g.: coughing up phlegm. Odour and sounds, e.g.: occurrence of incident/accident. Events and actions, e.g.: protocols for incident/accident.

Example 1:

Fran resides in her own home. She has a home care worker assisting with some personal care needs each day. In conversation, she mentions to her carer that she is experiencing pain in her neck when lifting the saucepan to drain the potato water. The carer reports on when the pain occurs and the activity undertaken.

Example 2:

Danny is a client with Dementia. You observe him going to the toilet frequently. When you go to assist him, you notice a fishy type smell. You recall this type of smell as being related to a previous infection that Danny had succumbed to. The carer reports, toilet frequency, which is outside of normal routine. Also smell and followup processes.
The examples presented provide some cues for documentation sometimes it is necessary to be descriptive, paint the picture of what is occurring. Sound documentation practice in aged care and community care agencies should facilitate and reflect the participation of residents/clients (or their designated representatives) in the care planning process. Types of records In your role as a care worker, you will most likely be involved on a regular basis in recording information about changes in a resident /clients condition and their ongoing care requirements. Many care agencies have developed a series of forms, which care workers are required to complete, in order to ensure continuity of care. You will need to familiarise yourself with the types of records used by care service providers, including: Information obtained for the purpose of identifying resident/client needs, including personal history and assessment. A formal and updated statement of resident/client needs. Details of specific needs (often listed in a care or service plan). Resident/client diary or daily records that need to be completed and signed by the care worker. Information from organisations and staff members who have accepted the responsibility to fulfil specific resident/client needs. Information associated with residential assistance or requests for residential assistance. Ongoing information related to resident /clients condition and health status. Evaluation of assistance provided to date. Specific incident reports. Medical history and records. Various consent forms.

Resident/client records and case history may include: All records related to the persons health status. Assessments. Plans of care. Progress notes.

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Test results.

The augmentation of resident/client records will be assisted by the completion of documentation that will personalise the records, such as: Development of personal profiles to assist in individualising cases or support services. Aged Care Assessment Team (ACAT) and Home and Community Care (HACC) assessment. Aged Care Funding Instrument (ACFI). Care/case plans. Service delivery plans.

In addition, the following forms used for day-to-day monitoring or communication will assist: Progress notes. Contact sheets. Continence assessment and management. Behaviour assessment. Medication orders and administration records. Nutrition record.

Some of the other types of documentation that may be required to be completed by workers in the aged care and community care sectors may include: Requisition forms (equipment or consumables). Workplace Health and Safety (WHS) documentation, e.g.: hazard or accident/incident reports. Maintenance requests for equipment or appliances.

Files must be clearly labelled. Each page must contain, at least: the details of the resident /clients name. date or birth. date of entry.

ongoing pages, e.g.: progress notes, must be numbered.

Maintenance of information sources


Remember that an enormous amount of information flows into and out from any organisation these days. Aged and community services organisations are no exception. While some of the information is not relevant to how an organisations operation works, and does not need to be kept, a great deal of it does need to be kept, recorded and stored appropriately. Information; that is kept within an organisation is usually kept for one of a number of reasons, which might include: Legal reasons. Technical reasons.

Administrative reasons. In this section, we will be focusing on the administrative reasons and, to some extent, the legal reasons for retaining information within an organisation. The information used for administrative purposes is often used as a basis for reporting at various levels. That information would normally originate in one or more of the organisations systems, policies or procedures. Most aged and community services will have systems in place to record/store some or all of the following types of information.

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The systems that are used by a given workplace will depend on a number of things, including the: Needs of the organisation. Type of work it does. Number of staff and residents/clients. Types of services offered to people/clients. Resources it has at its disposal.

Organisations policies and procedures. The types of information used and recorded in an organisation may include the following: Customer/client information Personal details. Health, medical and dental information. Financial details. Special needs wheelchair, walking frame, interpreter. Emergency contacts who to be contacted in the case of an emergency. Individual resident/client records assessment processes, individual appointments, with medical practitioners, advocacy support records. Records of valuables jewellery, electric appliances, other assets. care plans, and

Legal requirements contracts, guardianship papers, consent. Financial information Budgets. Cash flow money coming in, money going out. Banking procedures. Investments. Petty cash. Creditors and debtors who you owe money to and who owes you money. Bank fees and charges. Salaries and wages records. Donations and gifts. Accounts, receipts and invoices. Quotes.

Funding applications. Human resources information Staff skills resumes appraisals. Staff details names, addresses, leave entitlements. Awards and/or enterprise agreements. Staff meetings agendas, minutes. Training records. Superannuation.

Emergency procedures what to do in case of injury, illness. Workplace health and safety Hazard checks and reports. Records maintenance. Fire and accident procedures including evacuation. Manual handling procedures. Security information. First aid. Workers compensation.

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Accident/incident reports. In the case of workplace health and safety there are legislative requirements that all organisations are required to meet. Equipment Instruction manuals. Warranties. Maintenance records. Requisition and ordering for new equipment. Vehicle registration. Hire and rental. Cleaning and servicing. Asset register records all equipment owned by the organisation.

Stock and/or supplies Stock take records what stock/supplies are on hand. Spares spare parts or consumables used for equipment. Requisition forms from replacing stock.

Communications Telephone use. Incoming and outgoing mail. Claiming and reporting procedures for these processes. Minutes of meetings, agendas.

Reports for people in care, funding bodies, management board. All of this information and these records are used to establish and maintain relevant files and records for the organisation in question. For a typical residential aged care facility, these might include: Accounting records. Resident/client records. Assessment and referral records. Records of job/people visited. Sign on/sign off sheets. Purpose designed reporting forms.

The information in these records is often used to prepare reports of various kinds. These will be required by a variety of individuals or bodies and might include: Daily reports on people in care these might be to update and maintain the individual care plan, or to send information to a medical practitioner, member of the family or other interested parties. Reports to meet the requirements of funding bodies funding bodies will require a level of accountability from any organisation to whom they supply funding, this is likely to include regular reports. Organisational reports to a board of management or shareholders the people who operate an organisation are also accountable to either the shareholders of an organisation or a board of management appointed on behalf of the owners or shareholders; these too will require regular reports. Incident or accident reports these might include occurrences where a person/client has been injured, a medication error or a minor (or serious) accident in the workplace. It may also be a collation of statistical information used in the workplace. It may also be a collation of statistical information used to assess the level of safety being maintained in the workplace and where improvements need to be made.

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Activity reports particularly in a community centre there may be a variety of activities available in which people/clients can participate and management needs to be kept up- to- date with what is happening with these and how successful or otherwise they are. This assessment may be made through numbers attending or through client feedback surveys. Referral reports reports on a particular aspect of a people/clients health, medical condition or behaviours may be required for referral to another professional practitioner. Security of records We have seen to this point that dealing with the information required to meet administrative requirements involves dealing with a good deal of confidential and private information. It is important that you understand not only how to deal with the information but how it should be stored in order to maintain its confidentiality. The types of information that are kept within a community services organisations include almost every type of information used in such an organisation. That is, all correspondence, reports, submissions, media releases, forward plans, staff records, manuals, policies and procedures, log books, address and phone lists and people/client records. Any information that is to be kept must be stored in some way. Storage systems used within various organisations may include: Computers. Filing cabinets or compactus. Disk or compact disk boxes. Archive boxes or systems. Ring binders and folders. Bookshelves. Card file boxes. Books and journals and ledgers. Diaries. Whiteboards and pin boards.

Lets take a brief look at some of these and the confidentiality implications when using these systems. Computers Community services organisations will now, in general, use computers to store a wide range of records. Two highly confidential areas of information that may be stored on a computer are financial records of the organisation and personal information of both the staff and people using the service. Since personal computers are readily accessible, and most people have some level of knowledge of computers, it is important that this information is protected in some way. The simplest way to protect information on a computer is to apply a password to information that should not be accessed by everyone. It is important that passwords themselves are protected. It has little value, for example, if the password is written down and taped to the underside of the desk. If the password is protected adequately this is one way of keeping confidential information safe. Filing cabinet The confidentiality issue also applies to filing cabinets. Ideally, these should be lockable so that confidential information is stored in a lockable drawer. Although many filling cabinets have a locking system where locking the top drawer locks the whole cabinet, models are available with individual locks for each drawer so that information which will be needed on a daily basis may be stored separately in a drawer that is not permanently locked.

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DVD, CD or compact disk boxes These too could contain highly confidential information and, if they are to be stored on the premises, should be lockable. Only authorised personnel should have a key or access to a key. Disk boxes containing confidential information should then be secured in a locked cabinet, office or safe at the end of the day.

Financial journals and ledgers


Where financial information is not stored on a computer, but kept in a handwritten form, these journals and ledgers should also be protected. At the very least, they should be stored in a lockable office, ideally though, in a lockable cabinet or safe. This is particularly true where the financial records include personal details of staff and their pay details. Any information that is not of its nature confidential can be stored under any of the other methods. This can then be placed in a situation where anyone who needs to can access the information readily. Most of all when dealing with records and financial aspects of the organisations procedures it is important that all workers make themselves fully aware of their organisations security, privacy and confidentiality policies and maintain them at all times.

PARTICIPATE IN QUALITY IMPROVEMENT ACTIVITIES


Quality improvement has a focus on finding the underlying causes of errors or system failures so that their future occurrence can be reduced which is the basis of the best international accreditation systems. Aged care needs an accreditation system that takes this approach and is transparent, consistent and independent. Taking this approach means, that residential care accreditation must define and measure what is important to the older person who lives in residential care. Quality indicators to measure this should be based on: the clients population, including many people with dementia or receiving palliative care and the lack of an individuals choice in entering residential care, and associated family guilt, which impacts on how people view the care they receive.

This marks a significant shift from the current system which is process based and largely ignores quality of life or service outcomes.
www.agedcare.org.au/POLICIES.../ Accreditation-Review-Submission.pdf

Which mean representatives of external bodies do accreditations, they will come to the work place to: inspect the services, equipment and resources provided. observe staff going about their daily tasks. inspect workplace documentation. interview staff, residents and residents families and friends .

Organisations also conduct their own annual reviews to measure quality standards, organise internal audits to identify gaps in service quality or participate in a quality improvement program run by Australian Council on Healthcare Standards. In many workplaces, staff are given opportunities to comment on quality control and suggest improvement strategies. You need to participate fully in these activities as it is essential that everyone has their say about quality. Different people have different ideas. Its good to get ideas from everyone. Everyone gets asked in the organisation - the older person, employees and family members. Quality improvement activities The following table is how you can contribute to continuous improvement.

Identify hazards in the workplace and complete a form or notify your supervisor. Suggest how you think the hazard could be fixed Observe the workplace and think of
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You notice that a shower chairs wheel has come loose. You take it out of action by putting a hazard card on it. Complete the appropriate forms so there is a record of the incident. Advise your supervisor or maintenance to ensure the equipment can be fixed. You have noticed that when family members visit their relations
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ways to improve.

and are in the lounge room there is a limited number of chairs for them to be able to sit and often stand around their loved one. A suggestion is to increase the number of chairs available for family visitors in the lounge area. You notice that the supervisor has to repeat announcements for a different shift, so suggest information update notice to be placed in a prominent position. Or even an internal staff newsletter. Contribute ideas at staff meetings and in brainstorming sessions. Find out about appropriate courses, seminars or workshops that you could attend. Additional training might improve quality and time spent doing a task. Watch how more experienced people operate. Ask them for advice and suggestions for improvement.

Provide suggestions to improve work practices Be actively involved in meetings Plan to do more training

Observe experience workers

Example The following comment from an older person. What ways could you suggest to improve the quality of care? Mary, the person who looks after me, often rushes me to have a shower. I think she is rushing to get to the next job. I want to be able to take my time in the shower. I always feel as if I have to hurry.

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SUSTAINABILITY PRACTICES ................................................................................................


Increasingly more Australian women and men are working. There has been an increase of women working, of around 10 percent in 20 years to 1.8 million working leading to significant implications for how we live, work and care. This is occurring against the background of changing family shape, with only 40 per cent now 'traditional' nuclear families of two parents sharing biological children. With a third of marriages in 2001 predicted to end in divorce, and big increases in sole parent households, work and care arrangements have to accommodate many kinds of transitions over the life course. It is against this background that demands for childcare have grown. (Barbara Pocock, 2011 ECA website) While much attention focuses on the effects of work on the ability to care for children, combining care and work in the future is increasingly going to be about aged care, with a quarter of our population predicted to be over 65 by 2036. Work is generally associated with positive wellbeing and social inclusion outcomes for both men and women. Having a job is, overall, a good thing but only in the right circumstances. Giving up more household hours to work affects people's capacity to do other important things to care for each other; exercise; spend time with neighbours, friends and families; and undertake formal or informal voluntary work. (Barbara Pocock, 2011 ECA website)

DEFINITION
Sustainable development is a perspective or a vision rather than a definition and provides room for many different starting points. One of the more well known and widely used definitions of sustainable development comes from the Brundtland Commission report Our common future from 1987 in which it defines sustainable development as development that meets the need of the present without compromising the ability of future generations to meet their own needs. The message from the United Nations is that we must ensure that basic human needs may be satisfied for all human beings without damaging the life sustaining system of our planet. A clear common message in the perspectives and definitions gathered from different international contexts is that the time line encompasses several generations and that there is always a global perspective. Individual involvement and responsibility are also integral parts of the concept of sustainable development. The key principle is that economic, social and environmental conditions and processes are integrated into a whole, but also includes opportunities to approach this whole from all different directions.

SOCIAL
The Oxford Dictionary defines sustainable as capable of being upheld, maintainable and to sustain as to keep a person, community etc from failing or giving way; to keep in being; to maintain at a proper level; to support life in; to support life, nature etc with needs. Considering this, really we are looking at holistic approach to sustaining everyone on a social level. Some groups see social sustainability about maintaining populations or matching population to the resources available to sustain life. At present, this is a debate within the community. It has been referred to as the Human Carrying Capacity number of people that a land can support (Brown, Hansen, Liverman and Meredith in Forum for Global Stability Toward Definition in 1987) http://www.environment.arizona.edu/files/env/profiles/liverman/brown-hanson-liverman-and-merideth-1987em.pdf. This debate has been going on for decades and will continue to be part of the current social climate for the foreseeable future. The World Bank Social website states the social sustainability is Generally, societies that are inclusive, cohesive, and that have accountable institutions are best able to support lasting development outcomes.
A sustainable society is a society whose long-term prospects for continuing to exist are good. Such a society would be characterized by an emphasis on preserving the environment, developing strong peaceful relationships between people and nations, and an emphasis on equitable distribution of wealth. d Coop America, Coop America Quarterly, No. 37, Summer 1995, p 46.
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As you can see, social sustainability is really at a governmental level but it will affect our daily work lives especially in aged care. Now consider that the younger population will have to support and increasing ageing population which will put strain on the economy and the physical care of the aged. People are having fewer children as the planet will not be able to support large families which will in turn reduce the workforce. These are points to consider when looking at social sustainability. I am sure that you can think of more. Eng

ECONOMIC
There are many constraints in aged care linked the funding. According to the Department of Health and Ageing, expenditure on health and residential aged care as a percentage of Gross Domestic Product is projected to rise from 9.3 per cent in 2002-03 to 12.4 per cent of GDP by 2032-33. The scope of peoples universal entitlement to health care funded by public monies should be debated over time to ensure that it is realistic, affordable and fair and will deliver the best health outcomes. Health care priorities should be decided with consideration of the clinical, economic and community perspectives. In Australia, as around the world, people are living longer and therefore there is an increase economic and social strain on the population and in turn, governments to ensure that all people are cared for. According to the Department of Health and Ageing, the current overall balance of taxation, private health insurance and out of pocket, contributions is appropriate and should be maintained over the next decade. The current scope and structure of safety net arrangements needs to be reviewed to cover a broader range of health costs in a simple and integrated way that continues to protect people from unaffordable out-of-pocket costs. Incentives for improved outcomes and efficiency should be strengthened in health care funding arrangements should involve a mix of: activity-based funding; payments for care of people over a period of time; and reward payments for good performance and timeliness of care. A fit-for-purpose approach to funding models should be applied. This may involve changing the scope of payments available to include more than the existing fee-for-service model currently used. The Department of Health and Ageing discusses the need to support system changes and enhance efficiencies, priority areas for new capital investments including: establishment of Comprehensive Primary Health Care Centres; expansion of sub-acute services; investments to support expansion of clinical education across service settings; e-health including person-controlled electronic health records and data systems; targeted investments in hospitals to support reshaping of roles; and to enable capital to be raised through both government and private sectors.

WORKFORCE
The aged care workforce includes the management or delivery of aged care in any setting. As well as staff who provide hands-on care, the aged care workforce includes a range of skilled professionals such as allied health professionals, general and specialist medical practitioners, pharmacists and ancillary staff involved with facilities and services. A number of reports demonstrate concern about the current aged care workforce its size, skill mix, and availability. The recruitment and retention challenge facing aged care would rise if the overall Australian labour market became much tighter. But in that, they would not be alone. As the aged care workforce ages, the gap between workforce supply and demand is projected to increase13 as demand increases without a similar increase in supply. In the supply of registered nurses, there is an acknowledged shortage of nurses worldwide. The aged care workforce is predominantly female, and has a strong part-time and actualised structure. Workplace stress, increased injuries and high workplace health and safety risks are reported. Wage disparity compared with other sectors is a factor for many workers in aged care. http://www.health.gov.au/internet/main/publishing.nsf/Content/90A1E255138D80CACA256FE3001715E3/$File/na cws.pdf To ensure that there is enough care staff the government has undertaken strategies to ensure a sustainable workforce including:

specification of workforce categories within each model (e.g. registered nurse, enrolled nurse, assistant in nursing, care workers, other employees, allied health) and best means for utilisation in different contexts of care; mapping of current and future skills, roles and duties in a range of contexts; variations in work roles, job descriptions and role boundaries of workers in these contexts;

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prediction of met and unmet demand for skilled staff across categories, leakages or retention of staff to the system would be an issue for consideration also; level of consistency needed regarding nomenclature and job descriptions; and projected change in demographics of all residents (disability, dependency, dementia, ethnicity) and impact of this on projected workforce skills required.

As you can see, it is very complex to ensure that there is enough people to care for the aged in our community.

ENVIRONMENTAL
The healthcare sector is finding waste management issues to be increasingly important. Disposing of healthcare waste can have high costs and environmental implications. According to the Waste Management Guideline established by the Department of Human Services in Victoria, there are several strategies and containment measures that will assist us to understand what our obligations and requirements may include (http://www.capital.dhs.vic.gov.au/WasteManagementGuideline/) please see container information listed below. Waste management includes a variety of different aspects of working every day. Below are some areas of consideration as discussed by Queensland Department of Health (http://www.resourcesmart.vic.gov.au/for_government/waste_and_recycling_2376.html) as shown below.

Pests and disease


Food waste attracts pests and vermin, like feral pigs and rats. These pests and vermin can start or spread disease in the community. Piles of old garden waste and pieces of old furniture left in yards can shelter vermin and help them to breed. Dengue fever can be spread by mosquitoes that breed in anything that can hold water, like inside old car tyres, litter and even old palm fronds lying on the ground!

Poison and pollution


Illegally dumped pesticides, motor oil and other chemicals can contaminate land, creeks, and water supplies. People drinking or swimming in polluted water can get sick. Councils are required by law to clean up land contaminated with chemicals that they dispose of. Chemical clean-ups can be very expensive.

Human waste and diseases


It is very important to keep human waste out of water supplies. Human waste (faeces, poo, kuma, urine, wee) contains diseases that make people sick. Human waste can get into the local water supplies from leaking septic tanks, releasing contaminated water from sewerage treatment plants, dirty nappies, leaking sewerage pipes and people using local creeks as a toilet.

Injury and disease


People can get diseases like tetanus and leptospirosis if they cut or scratch themselves on pieces of metal, nails or glass. Children can be seriously hurt by playing with old car batteries or household cleaners that they find lying around.

Litter
Litter can be a problem in any community. Broken bottles and tins, for example, can cause injury if people do not put them into bins. Mosquitoes and other vectors can breed in water trapped in old tyres and bottles. People are more likely to drop litter in places that already have litter lying around. If they see litter on the ground, they may think it is OK for them to also throw their litter on to the ground. Without providing ways for people to stop littering, the whole community can be affected because they do not want to live in a dirty town.

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This hierarchy lists ways of managing waste problems. The best option is to avoid creating waste in the first place. The worst option is to bury waste at a rubbish tip. Option Avoid creating waste Re-use waste Recycle waste Recover energy from waste Dispose of waste safely Example Ask suppliers not to package the goods they provide, where appropriate If goods have to be packaged, ask the supplier to take back the packaging Use packaging for storage Burn waste in a legal incinerator to heat water for council or community use Bury waste in a council landfill/rubbish tip

Containment of materials http://www.capital.dhs.vic.gov.au/WasteManagementGuideline/


All areas All areas of a facility must provide designated containment requirements of the following attributes: waste containers such as skips, wheelie bins, bucket bins, sharps containers, cages for storing the following, but not limited to: rubbish (general waste) recycling (full and partial commingled) confidential paper waste redundant (hard waste) materials for re-use sharps waste clinical waste related wastes materials such as cardboard must be appropriately compacted or baled waste container colours should be aligned with Australian standard AS 4123.7 and ANZCWMIG Industry code of practice for the management of clinical and related waste 5th edition 2007.

Types of containers
All areas Waste containers (skips, wheelie bins, bucket bins, sharps containers, cardboard compactors, rubbish compactors) should meet Australian standards. For more information about clinical and related waste containers, refer to Industry code of practice for the management of clinical and related waste 5th edition 2007. Designing Waste Storage Areas Space Sufficient space in the facility areas must be provided for waste containers and equipment as well as waste likely to generate on the premises between collection periods. When designing waste storage areas in healthcare facilities, designation of the following locations needs to be considered. Ward/department disposal areas There is a requirement for sufficient space to be designated within the ward/department disposal area for waste containers and waste generated between collection periods. Central bulk disposal areas There is a requirement in the central bulk disposal areas to provide separate designated areas for: clean, empty or used waste containers secure areas temperature-controlled areas caged storage areas

Location of Waste Containers


All areas There is a requirement for all disposal areas to be well located for: convenient disposal for users sited away from food preparation and general storage areas and from routes used by the public
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safe and efficient movement across the healthcare facility and from disposal area to disposal area such as ward/department disposal area to central bulk disposal area safe and efficient accessibility for collection contractors central bulk central storage areas would be located and designed out of public view from the road, patient and public areas, public walkways, near car parking or adjacent to neighbouring residential/ commercial/educational properties waste/recycling contained in cages, secure or temperature-controlled areas must be placed in a location where collection trucks, or collection person/s permit easy, convenient and safe access.

Design Aspects of Waste Storage Areas


Ward/department disposal areas point of production There is a requirement in the ward/departments for secure disposal area sufficient in size to allow for waste to be separated. The ward/department disposal area should provide adequate for space for: containment of waste containers such as wheelie bins for adequate separation of rubbish, recycling and reusable materials including rubbish, recyclable materials, confidential paper, clinical waste and sharps waste during and between collection periods movement of waste materials including manual handling Central bulk disposal areas Central bulk disposal areas for should support the following attributes when planning waste storage areas. It should be noted that central storage areas should be sited away from food preparation, storage areas and walkways used by the public. Clean, empty or used waste container area should be adequately sized to provide enough space for: containment of a variety of empty and used waste containers including wheelie bins, sharps containers and skips for rubbish, recycling, re-use materials including rubbish, recycling, confidential paper and other paper during and between collection periods (this space needs to accommodate all items which are collected from one central location by the waste contractor) equipment including compactors and bailers easy accessibility for cleaning adequate ventilation to prevent build up of odours clear signage and labelling on all door and entrances spill response kit. Secure areas should provide enough space for some clinical waste materials such as sharps and cytotoxic waste that require storage in secure areas. These areas should be adequately sized to provide enough space for: containment of used containers including sharps containers and pails for cytotoxic waste to be stored until collection easy accessibility for movement of waste containers easy access for cleaning visual screening from public areas adequate ventilation to prevent build up of odours clear signage and labelling on all door and entrances spill response kit Temperature-controlled areas are required for storing some materials such as clinical waste, clinical waste for incineration only or some related wastes to be stored in a temperature-controlled area. Food waste must also be chilled if not collected within three days of generation. Where waste storage area is temperature controlled, the temperature should be maintained at or below 5-7C. These areas should be adequately sized to provide enough space for: adequate ventilation to prevent build-up of odours clear signage and labelling on all door and entrances spill response kit. Caged storage areas are required for storage of larger items or materials with inherent value such as mattresses, electronic equipment, desks, chairs and office equipment for example. These items must be stored in a caged storage area to reduce the risk of WHS issues arising. These areas should be adequately sized to provide enough space for: adequate ventilation to prevent build up of odours
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clear signage and labelling on all door and entrances spill response kit. Other design attributes to consider in central bulk storage areas include the following: Bin servicing or repair areas should be adequately sized to provide enough space for: containment areas for damaged or new waste containers adequate space for service staff to work with containers to remove and replace wheels and lids safely and without obstruction or WHS issues. Bin washing facilities must include taps. In addition: the floor surface should be washable with smooth surface and must drain to sewer the concrete floor graded and drained to sewer the area must be undercover to prevent rainwater from entering wash water wash areas are required where waste containers are the responsibility of the facility discharging of wash water must be stated as acceptable on the facilities Trade Waste Agreement. There is a requirement for all waste disposal areas to consider accessibility and movement of waste containers. Design shall allow for adequate vehicle access, manoeuvring and loading into collection vehicles as well as visual screening from public areas. Noise Noise affecting staff, patient, visitors, public and surrounding properties should be considered when choosing location of all waste storage areas. Lighting Sufficient lighting must be provided. Ventilation and odours There should be adequate ventilation to prevent build up of odours. All disposal areas must have their own extraction ventilation system. Mechanical exhaust systems shall comply with AS1668 and not cause any inconveniences, noise or odour problems. Water supply and hydraulics A floor waste basket trap connected to the sewer is required within central waste containment areas. A tap facility should also be provided.

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