Unit 009 (3565) (HSC2031 4222-235) Knowledge Workbook

Contribute to u!!ort o" !oiti#e rik-t$king "or indi#idu$l

C$ndid$te n$%e& C'( )eg* +o&
C$ndid$te ign$ture&
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This unit is aimed at those working in a wide range of settings. It provides the learner
with the knowledge and skills required to contribute to supporting positive risk-taking
to benefit individuals.
This unit must be assessed in accordance with Skills for Care and Development's
C!
"earning outcomes # and $ must be assessed in a real work environment and %our
&ssessor will arrange to observe %our practice
'ou must understand %our organisation(s policies and procedures before attempting
to answer the learning outcomes
)ead the guidance on the terms used in this workbook before %ou start.
*age + of ,,
Centre
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*age , of ,,
C$ndid$te 0e%ent )e-ord
Unit +u%ber& 009
Unit 4itle& Contribute to u!!ort o" !oiti#e rik-t$king "or indi#idu$l
,$te Workbook ub%itted& 1t ----------.. 2nd ----------..
"earning
.utcome
&ssessor !eedback +st Submission .utcome
*ass/)efer
,nd Submission
.utcome
*ass/)efer
+.+
+.,
+.0
,.+
,.,
0.+
1.+
1.,
"earning outcomes # and $ must be assessed in a real work environment and %our
&ssessor will agree additional methods to cover these2 including observation of %our
practice
*age 0 of ,,
&ssessor comments to Candidate
Target date and action plan for resubmission 3if applicable4
.utcome of second submission
I confirm that this assessment has been completed to the required standard and
meets the requirements for validit%2 currenc%2 authenticit% and sufficienc%
&ssessor Signature5 Date5
I confirm that the assignment work to which this result relates2 is all m% own work
Candidate Signature5 Date5
Internal 6erifiers Signature5 Date5
*age # of ,,
0ddition$l guid$n-e
&n individual is someone requiring care or support
*erson-centred reflects what is important to individuals and helps them to live
the life the% choose
*olicies ma% include5
7ational polic%
"ocal polic%
.thers ma% include
The individual
Colleagues
!amilies or carers
!riends
.ther professionals
8embers of the public
&dvocates
&greed wa%s of working will include policies and procedures where these e9ist.
5or %ore det$iled in"or%$tion !le$e ree$r-6&
www.al:heimers.org.uk
http5//www.scie.org.uk/publications/dementia/inde9.asp
http5//www.dh.gov.uk/prod;consum;dh/groups/dh;digitalassets/<dh/<en/<ps/docu
ments/digitalasset/dh;+,+#=0.pdf
http5//www.o9onsafeguardingadults.org.uk/wps/wcm/connect/occ/Safe>!rom>?arm/
*rofessionals/
http5//www.cambridgeshire.gov.uk/7)/rdonl%res/#1=@=C&A-$+A,-#0B$-A1#A-
C$,B+1$D$1D@/B/)estraint.pdf
*age $ of ,,
.e$rning 1ut-o%e 1*1& $!e-t o" e#er7d$7 li"e in w6i-6 rik !l$7 $ !$rt
1
Diving people choice and control in their lives involves some element of risk and this
review looks at the comple9 task of balancing risks and opportunities for people with
dementia. ?ealth and social care organisations and professionals can sometimes
face tensions between balancing risks and opportunities for individuals and their dut%
to care for individuals deemed to be Evulnerable( 3Ta%lor2 ,B+B42 emplo%ees2 and the
wider public 38itchell F Dlendinning2 ,BB@G Carr F )obbins2 ,BB=4.
In the case of people with dementia2 vulnerabilit% tends to be seen in terms of
increased risks to their safet%2 or that of others2 and their risk of being e9posed to
abuse or e9ploitation.
6ulnerabilit% is a term that ma% be useful in indicating that a person ma% be at a
higher level of risk from harm because of a disabilit% or illness but instead of thinking
about vulnerable people2 it might be better to think about how people with dementia
often live in vulnerable situations.
Definitions of risk change. Terms like Epositive risk taking( and Erisk enablement( help
us to take account of potential benefits as well as disadvantages when assessing
risk.
& risk is the likelihood that a ha:ard will actuall% cause its adverse effects2 together
with a measure of the effect. 3?ealth and Safet% C9ecutive2 Hndated4
&ll those %ou care for enIo% the same rights as %ou2 including the right to make
choices and take risks. "iving a full and enIo%able life e9poses ever%one to a variet%
of risks5 going out alone2 driving a car2 forming new relationships2 taking part in
sports2 crossing bus% roads2 the list is endless. ?owever2 most of these risks are
quite eas% for us to Iudge and decide whether the activit% is worth taking the risk.
!or e9ample2 %ou ma% be late for work and need to cross a bus% road. 'ou know
there is a safe crossing place further down the road but it will take up valuable time
to get there. 'ou quickl% make a Iudgement that %ou can run across the road when
there is a gap in the traffic because5
J %ou are quite fit
J %our sight and hearing are good enough to help %ou decide when to go.
'ou have the right to make the choice to take the risk as %ou have made an informed
decision about the possible consequences of doing it 3getting knocked downK4
+
E7othing 6entured2 7othing Dained(5 )isk Duidance for people with dementia www.dh.gov.uk
*age 1 of ,,
Those %ou care for ma% need more guidance in how to Iudge the possible
consequences of their actions but the% still have the right to make choices and take
risks. 'our role is to support them in doing so.
.e$rning 1ut-o%e 1*2& t6e -one8uen-e "or indi#idu$l o" being !re#ented or
di-our$ged "ro% t$king rik
)isk assessments need to consider the impact on people with dementia(s wellbeing
and autonom% as well as the possible risks to their ph%sical safet%.
Decisions about risk should not assume that all people with dementia are Eat risk( but
should be based upon understanding of individuals and their own understanding of
the risks the% ma% face.
LCach da% brings its own catalogue of risks2 some minor and some dangerous. Aut
over time and with forgetting2 there is the risk of being put on the side lines2 of being
seen as a hindrance2 and having control taken awa% from %ou2 under the guise of it
being for %our own good. So2 while we can2 we must challenge the risks- *eople
living with a dementia must be allowed to take risks2 because if we don(t2 we are in
danger of rela9ing into the disease. &t times we feel hopeless. &t times the hurt we
feel is indescribable and we can let it be a barrier to life. Aut there is a life for us2 if
we risk it.M
3*ersonal account of living with dementia2 8organ2 ,BB=2 ,N4
.e$rning 1ut-o%e 1*3& e9!l$in 6ow u!!orting indi#idu$l to t$ke rik -$n
en$ble t6e% to 6$#e -6oi-e o#er t6eir li#e to&
g$in in el"--on"iden-e
de#elo! kill
t$ke $n $-ti#e !$rt in t6eir -o%%unit7*
LThe sa%ing Enothing ventured2 nothing gained( makes the point that unless someone
takes a risk and tries new activities2 the% will never know of the positive benefits that
might result. In our societ%2 people are encouraged to travel widel%2 take part in
regular leisure and sporting activities2 go to college2 develop careers2 and have
families. These are all activities that don(t Iust happen2 but mean people have to take
risks to achieve their aspirations.M
3Dateshead Council2 ,BB=4
LOe had a %ounger person with dementia attending our social group but what she
reall% wanted to do was to go back to working in a shop. &nd there was our charit%
shopK Oe thought that she would be able to manage if we gave her some support as
*age @ of ,,
it was her an9iet% that was reall% the problem. So a support worker went with her for
the first three weeks and that has made all the difference to her confidence.M
3Chief C9ecutive2 6oluntar% organisation4
8an% people with dementia want to continue to travel outside their home. Support
workers to accompan% the person with dementia2 help cards2 and assistive
technolog% can all help people with dementia to go outside safel%.
.e$rning 1ut-o%e 2*1& 6ow $ !eron--entred $!!ro$-6 to rik $e%ent
-$n u!!ort !oiti#e out-o%e
& good qualit% of life2 a good end of life2 and good outcomes are essential for us all.
?aving dementia does not e9empt a person from such aspirations. 8ost people
would agree that a life without risk would be rather unadventurous and dull. )isk is
vital for positive feelings2 e9periences and achievements. "ife with dementia can still
be a life worth living.
& good risk assessment should demonstrate that risk has been assessed and
managed taking into account all perspectives and all aspects of the individual(s
needs. *ractitioners should demonstrate that the% have used all means available to
skilfull% communicate with the person with dementia to best understand their
individual needs and wishes.
!inding out more about how much a person with dementia knows about dementia
and its impacts could be one wa% of helping him or her to reach decisions about risk.
)isk enablement strategies need to identif% the likelihood of the risk and its
seriousness.
"ife stories and other biographical approaches can help establish how people with
dementia have developed an approach to risk over their lifetime. If professionals and
paid workers do not know the person well the% might not be aware of the wa%s in
which the individual alread% manages risk2 or how their famil% or supporters have
alread% built up s%stems of support. ?ere2 it is important to have discussions with the
individual and those closest to them and pa% close attention to what the% sa%. The%
ma% be managing some risks well and Iust need support to e9ercise this power. In
other areas2 the% ma% appreciate specialist knowledge and e9perience. There is
evidence that people with dementia and their famil% carers welcome information and
advice2 especiall% when it is tailored to the individual and sensitive to current worries.
.e$rning 1ut-o%e 2*2& t6e "e$ture o" $ !eron--entred $!!ro$-6 to rik
$e%ent
*age N of ,,
&lthough there is little research from which to draw clear conclusions on specific
interventions aimed at promoting independence2 the 7ICC-SCIC dementia guidelines
37ational Collaborating Centre for 8ental ?ealth2 ,BB14 concludes that it is good
practice to promote independence at all stages of dementia. &dvice from the
&l:heimer(s Societ% 3,BBNd4 suggests that memor% aids and other reminders can
help a person with dementia to retain their skills for longer. These ma% be of most
help in the earl% stages of dementia when the person is better able to understand the
message and to act upon it. *romoting independence is a wa% of minimising risks
and ma9imising opportunities for people with dementia.
Ideas include5
labelling cupboards and drawers2 perhaps using pictures rather than words P
for e9ample2 a photo of a cup and Iar of coffeeG
a large calendar showing the da%2 month and %earG
a notice board for messagesG and
notes stuck b% the front door.
3&l:heimer(s Societ%2 ,BBNd2 04
Cnabling a person to keep their skills ma% seem on the face of it to present some
risks but there is consistent advice that sta%ing active as long as possible avoids
adding to distress or an9iet% and contributes to the person with dementia(s qualit% of
life.
Shared approaches to risk are needed to avoid misunderstanding and clarif% which
decisions have been taken. Shared approaches ma% not alwa%s result in shared
agreement but it is important to establish who thinks what and wh%.
Sharing a risk assessment with a range of people with different backgrounds and
e9periences ma% be more helpful than Iust talking about it with a group of colleagues
who often share the same views and values. Some organisations 3for e9ample2
"ondon Aorough of 7ewham2 ,BB=4 have created panels or forums to provide advice
in the case of comple9 risk decisions. ?owever2 the effectiveness of these
developments has %et to be evaluated.
*ositive risk-taking is weighing up the potential benefits and harms of e9ercising one
choice of action over another. This means identif%ing the potential risks involved2 and
developing plans and actions that reflect the positive potentials and stated priorities
of the individual. It involves using available resources and support to achieve desired
outcomes2 and to minimise potential harmful outcomes.
*ositive risk-taking is not negligent ignorance of the potential risks. 7obod%2
especiall% users or providers of a specific service or activit%2 will benefit from allowing
risks to pla% out their course through to disaster. So2 in practice it is usuall% a
*age = of ,,
carefull% thought-out strateg% for managing a specific situation or set of
circumstances. 38organ2 ,BB#4
.e$rning 1ut-o%e 3*1& legil$ti#e "r$%ework $nd !oli-ie t6$t -$n be ued to
$"egu$rd indi#idu$l "ro% rik w6ilt !ro%oting t6eir rig6t*
.lder people who need care and assistance have the right to take decisions about
their lives2 unless their freedom to do so is constrained b% legislation.
.lder people who can make their own decision should decide and control their own
care2 including an% decisions to be made about restraint. There are2 however2 some
people who need support in making decisions and a growing number of older people
with dementia who have limited mental capacit% to make decisions for themselves.
The 8ental Capacit% &ct ,BB$ provides the proper framework for reaching decisions
as to what is in people(s best interests
*eople with dementia should be encouraged to make as man% decisions as possible
for themselves using the five core principles of the 8ental Capacit% &ct ,BB$.
+. & person must be assumed to have capacit% unless it is established that the%
lack capacit%.
,. & person is not to be treated as unable to make a decision unless all
practicable 3doable4 steps to help him to do so have been taken without
success.
0. & person is not to be treated as unable to make a decision merel% because he
makes an unwise decision.
#. &n act done or decision made2 under this &ct for or on behalf of a person who
lacks capacit% must be done2 or made2 in his best interests.
$. Aefore the act is done2 or the decision is made2 regard must be had to
whether the purpose for which it is needed can be as effectivel% achieved in a
wa% that is less restrictive of the person(s rights and freedom of action.
38ental Capacit% &ct ,BB$4
4wo-t$ge "un-tion$l tet o" -$!$-it7
In order to decide whether an individual has the capacit% to make a particular
decision %ou must answer two questions5
*age +B of ,,
Stage +. Is there an impairment of or disturbance in the functioning of a person(s
mind or brainQ If so2
Stage ,. Is the impairment or disturbance sufficient that the person lacks the
capacit% to make a particular decisionQ
The 8C& sa%s that a person is unable to make their own decision if the% cannot do
one or more of the following four things5
J understand information given to them
J retain that information long enough to be able to make the decision
J weigh up the information available to make the decision
J communicate their decision P this could be b% talking2 using sign
language or even simple muscle movements such as blinking an e%e
or squee:ing a hand.
Cver% effort should be made to find wa%s of communicating with someone before
deciding that the% lack capacit% to make a decision based solel% on their inabilit% to
communicate. &lso2 there is a need to involve famil%2 friends2 carers or other
professionals.
The assessment must be made on the balance of probabilities P is it more likel% than
not that the person lacks capacit%Q 'ou should be able to show in %our records wh%
%ou have come to %our conclusion that capacit% is lacking for the particular decision.
*age ++ of ,,
Deprivation of libert% 3Do"S4
,
Oho is covered b% the 8ental Capacit% &ct and Deprivation of "ibert% SafeguardsQ
The safeguards appl% to people in hospitals or registered care homes2 who meet all
the following criteria. & person must5
be aged +N or overG
have a mental disorder 3as defined b% the 8ental ?ealth &ct4 such as
dementia2 learning disabilit%G
lack the capacit% to consent to arrangements being proposed for their care
and/or treatmentG and
need to be restricted to such a degree that this amounts to deprivation of
libert% 3in terms of the ?uman )ights &ct4 in their own best interests to protect
them from harm.
There is no simple definition of deprivation of libert%. The question of whether the
steps taken b% staff or institutions in relation to a person amount to a deprivation of
that person(s libert% is ultimatel% a legal question2 and onl% the courts can determine
the law. The Code of *ractice 38inistr% of Rustice2 ,BBN4 offers guidance.
The Curopean Court of ?uman )ights 3CCt?)4 has drawn a distinction between the
deprivation of libert% of an individual 3which is unlawful2 unless authorised4 and
restrictions on the libert% of movement of an individual. The difference between
deprivation of libert% and restriction upon libert% is one of degree or intensit%. The
CCt?) and HS courts have determined a number of cases about deprivation of
libert%.
Their Iudgments indicate that the following factors can be relevant to identif%ing
whether the steps taken involve more than restraint and amount to a deprivation of
libert%. It is important to remember that this list is not e9clusiveG other factors ma%
arise in future in particular cases5
)estraint is used2 including sedation2 to admit a person to an institution where
that person is resisting admission.
Staff e9ercise complete and effective control over the care and movement of a
person for a significant period.
Staff e9ercise control over assessments2 treatment2 contacts and residence.
& decision has been taken b% the institution that the person will not be
released into the care of others2 or permitted to live elsewhere2 unless the
staff in the institution considers it appropriate.
,
http5//www.o9fordshire.gov.uk

*age +, of ,,
& request b% carers for a person to be discharged to their care is refused.
The person is unable to maintain social contacts because of restrictions
placed on their access to other people.
The person loses autonom% because the% are under continuous supervision
and control.
!urther legal developments have occurred since this guidance was issued2 and
healthcare and social care practitioners need to keep themselves informed of legal
developments that ma% have a bearing on their practice. Oithin local councils the
manager with responsibilit% for Do"S or the 8C& will be the best source of advice
and information.
Oe know little about the risks of abuse e9perienced b% people with dementia and so
there is little to guide practitioners about effective approaches. Oe know from
tragedies and scandals in care and health services that some people with dementia
are subIected to poor care but we are less clear how much of this arises from their
dementia or from other disabilities and their living situations. This is not to
underestimate the severit% of these issuesG rather to highlight that risk management
strategies might focus more on the identification of those at risk rather than assume
that ever%one has an equal chance of being affected.
.ne ke% point for practice is that instead of using the word Erisk( we ma% be better
able to ensure that support is addressing the real problem if we start to think of the
Erisk ofQ( approach. In an e9ample of a bus% care home2 practice ma% lead to
different risks for different residents2 some quiet residents might be at risk of being
neglectedG others might be at risk of Erough handling( if the% are ver% slow or
seemingl% uncooperative with care.
0
*eople find it hard to understand wh% an%one would want to abuse an older person2
someone with a ph%sical disabilit% or learning disabilit%2 or someone who is unwell.
Aut someone suffering some mental and/or ph%sical frailt% is the perfect victim5 the%
can(t defend themselves2 the% can(t get awa%2 and even if the% are able to
communicate the% ma% not be believed.
&buse does not have to be deliberate2 malicious or planned either. It sometimes
happens that people are tr%ing to do their best but don(t reall% know what is the right
thing to do or find themselves at the end of their tether in difficult circumstances.
&s a care professional %ou have a dut% to help prevent abuse and report it where
%ou think it is happening
0
http5//www.o9onsafeguardingadults.org.uk/wps/wcm/connect/occ/Safe>!rom>?arm/*rofessionals/
*age +0 of ,,
.e$rning 1ut-o%e 6*1& 6ow t6e !rin-i!le o" dut7 o" -$re -$n be %$int$ined
w6ile u!!orting indi#idu$l to t$ke rik
)isks change as dementia progresses. *ositive risk taking helps people with
dementia and their carers deal with each of these changes as the% happen.
?ealth and social care organisations have what is called a dut% of care towards the
people the% look after. That means the% must do ever%thing the% can to keep the
people in their care safe from harm.
)isk management helps us keep people safe. *art of risk management involves
recognising and reporting adverse events2 incidents2 errors and near misses.
#
Staff working in health and social care have a dut7 o" -$re towards those with
whom the% are working. This term is sometimes used loosel% b% people to declare
that the% have to keep people safe. It is the role of staff to keep people safe but
should not be interpreted as protecting people from all risks or an% incident
whatsoever.
EIndependence2 choice and risk( defines dut% of care as an Lobligation placed on an
individual requiring that the% e9ercise a reasonable standard of care while doing
something 3or possibl% omitting to do something4 that could foreseeabl% harm
othersM.
The definition makes an important distinction between putting people at risk and
enabling people to make their own choices and to take reasonable risks. Ohen
people voluntaril% choose to live with a level of risk 3and have mental capacit% to
make these decisions42 there can be no breach of dut% of care.
&s a worker in the social care sector %ou and %our emplo%er are e9pected to work to
the standards set out b% the DSCC Codes of *ractice.
The purpose of this code is to set out the conduct that is e9pected of social care
workers and to inform Service Hsers and the public about the standards of conduct
the% can e9pect from social care workers. It forms part of the wider package of
legislation2 practice standards and emplo%ers( policies and procedures that social
care workers must meet. Social care workers are responsible for making sure that
their conduct does not fall below the standards set out in this code and that no action
or omission on their part harms the wellbeing of Service Hsers.
&sk %our manager for the full cop% of the code to look at or go to www.gscc.org.uk
and download it in one of ,= languages
#
http5//www.cambridgeshire.gov.uk/7)/rdonl%res/#1=@=C&A-$+A,-#0B$-A1#A-
C$,B+1$D$1D@/B/)estraint.pdf
*age +# of ,,
.e$rning 1ut-o%e 6*2& $-tion to t$ke i" $n indi#idu$l de-ide to t$ke $n
un!l$nned rik t6$t !l$-e 6i%:6erel" or ot6er in i%%edi$te or i%%inent
d$nger*
&n &ustralian stud% 3Oaugh2 ,BB=4 reports that interviewees identified a number of
critical times in the lives of the persons with dementia that placed them at risk.
Ohile recognising the uniqueness of ever% person with dementia with whom the%
worked2 the% felt that there were Ecritical times( in their life that posed special risks.
These were5 at the time of diagnosisG if changes occurred in the person(s behaviourG
when there was a decline in their ph%sical healthG and as their social and life skills
diminished resulting in increasing dependence or disabilit%.
LTwo weeks Tbefore entering long term careU2 we had been c%cling in ?olland -I
asked the consultant how it was possible to deteriorate this quickl%. ?e said
something reall% useful5 that it(s like walking on thin ice and the ice is getting thinner
and thinner but %ou don(t especiall% notice P until suddenl% %ou fall through and %our
world is suddenl% so different.M 3)achel2 in Ohitman2 ,B+B2 #=4
Some people with dementia ma% not have the time to wait for length% decisions
about risk. Ohile this t%pe of sudden decline ma% be more associated with vascular
dementia2 which can have a step like progression2 people with dementia ma% be at
risk of other illnesses. There ma% onl% be the one opportunit% for them to undertake
a much missed familiar activit% or to take the chance of tr%ing something new. !amil%
carers ma% value the support of practitioners to make the most of these possible
windows or last chances. Such positive risk taking can be ver% positive in terms of
building up trust and relationships between people with dementia2 famil% carers2 and
practitioners.
*age +$ of ,,
"earning .utcome +.+5 aspects of ever%da% life in which risk pla%s a part
"earning .utcome +.,5 the consequences for individuals of being prevented or
discouraged from taking risks
Think about an individual who has dementia and describe three of the man% aspects
of their dail% activities in which risk pla%s a part.
Dail% activit% that is risk% for
the individual
Ohat the possible
consequences could be
for the indi#idu$l if the%
are prevented from doing
the activit%
?ow the risk is
reduced to an
acceptable level for
all 3including the
individual4
+
,
0
*age +1 of ,,
Dail% activit% that is risk% for
the individual
Ohat the possible
consequences could be
for the indi#idu$l if the%
are prevented from doing
the activit%
?ow the risk is
reduced to an
acceptable level for
all 3including the
individual4
*age +@ of ,,
"earning .utcome +.05 provide an e9ample of how supporting individuals to take
risks can enable them to have choice over their lives
*ositive outcome for the individual Oa%s the% can achieve this
3, e9amples for each4
gain in self-confidence
develop skills
take an active part in their communit%.
*age +N of ,,
"earning .utcome ,.+5 how a person-centred approach to risk assessment can
support positive outcomes
"earning .utcome ,.,5 the features of a person-centred approach to risk
assessment
&nal%se %our service(s $!!ro$-6 to risk assessment for the individuals with
dementia %ou support. Ohat evidence supports that it is a person centred approach
to risk assessmentQ Ohat else would need to be done to ensure the approach is
totall% focussed on the individualQ 38inimum +$B words4
*age += of ,,
"earning .utcome 0.+5 legislative frameworks and policies that can be used to
safeguard individuals from risks whilst promoting their rights
L&nna SouthcottV2 @12 has dementia and lives in a care home. She has asthma. ?er
capacit% fluctuates. The district nurse attends to administer flu vaccinations. 8s
Southcott is able to communicate.M
Ohat steps must the District 7urse take before administering the flu vaccination and
wh%Q 38inimum +BB words4
*age ,B of ,,
"earning .utcome 1.+5 how the principle of dut% of care can be maintained while
supporting individuals to take risks
"earning .utcome 1.,5 actions to take if an individual decides to take an unplanned
risk that places him/herself or others in immediate or imminent danger.
Think about an individual who has dementia that %ou support. Describe a behaviour
that could put them 3or has put them4 at immediate risk of
$
harm. Then e9plain how
%ou would maintain %our dut% of care 3or have alread% done so4 whilst keeping them
safe. 38inimum +BB words4
$
an% ph%sical damage to the bod% caused b% violence or accident or fracture etc.G the occurrence of
a change for the worseG the act of damaging something or someone
*age ,+ of ,,
.nce complete please make sure that %our details are on the front of the workbook
and then return it to %our assessor5
.9care
.9fordshire "earning and Skills Service
Hnipart ?ouse
Darsington )oad
Cowle%
.W# ,D
*age ,, of ,,