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BETTER PRACTICE PROJECT Aged & Community Services SA/NT Coordinators’ Handbook Imagining possibilities A practical handbook for working with people in the community
Transcript
Page 1: Imagining possibilities - Aged & Community Services SA & …agedcommunity.asn.au/.../2015/06/Imagining-Possibilities-handbook.pdf · Imagining possibilities ... gives “life” to

BETTER PRACTICE PROJECT

Aged & Community Services SA/NTCoordinators’ Handbook

Imagining possibilities

A practical handbook for working with people in the community

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PuBlIshIng dETAIls

Citation: Better Practice Project (2014). 2nd Edition. Imagining possibilities: A practical handbook for

working with people in the community. Aged and Community Services SA/NT. Adelaide.

© Better Practice Project

Handbook compiled by Ronda Held www.rondaheld.com.au. Revisions for 2015 edition by Jane Sherwin www.sherwinconsulting.com.au.

Edited by Anna Held.

Graphic Design by Sinead Murphy, Lovelock Studio www.lovelockstudio.com.au

Stories used with permission.

COnTACT dETAIls

Joyleen Thomas – Manager, Better Practice Project Aged & Community Services SA & NT

246 Glen Osmond Road, Fullarton SA 5063

T 08 8338 7111F 08 8338 7077

W http://www.agedcommunity.asn.au/providers/better-practice-project/resources-publications/E [email protected]

“WArning: This publication may contain the names and images of Aboriginal and Torres Strait Islander people now deceased. The publication may also contain references to sites and publications that may use images of Aboriginal and Islander people now deceased.”

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Foreword v

About Appreciative Inquiry vi

About the Handbook vii

dIsCOvERy 1

Discovery 1: Be prepared 2

Discovery 2: Develop a power-with relationship 4

Discovery 3: Appreciate the person 7

Discovery 4: Demonstrate respect 9

Discovery 5: Find Strengths 12

Discovery 6: Identify networks 16

Discovery 7: Understand diversity 19

Discovery 8: Understand needs 22

dREAm 28

Dream 9: Imagine a positive future 29

Dream 10: Strengthen and/or identify new valued roles 33

Dream 11: Strengthen Relationships 36

Dream 12: Have health and wellbeing 41

Dream 13: Facilitate choice and control so people are decision makers in their life 46

Dream 14: Explore the possible contributions of family, community and service 50

Dream 15: Use creative thinking 53

dEsIgn 58

Design 16: Agree on the goals that will work towards the vision of a positive future 59

Design 17: Scope of responsibilities 64

Design 18: Think typical and personal 67

Design 19: Co-design for both formal and informal responses 71

Design 20: Co-design for a positive home life 75

Design 21: Coordinate, Resource and Refer 77

Design 22: Co-design for community participation and informal networks 79

Design 23: Co-design for building capabilities 84

Design 24: Responding to a person’s grief 86

Design 25: Advocacy and safeguarding 88

Design 26: Develop helpful administrative and organisational processes 90

dElIvER 92

Deliver 27: Agree on the partnership to arrange supports 93

Deliver 28: Check in 95

Deliver 29: Flexible Responses 98

Deliver 30: Monitor outcomes and staff performance 100

Deliver 31: Monitor administrative and organisational matters 102

Deliver 32: Endings – graduation, celebration, and letting go 104

REFEREnCEs 107

C O N T E N T S

CON

TENTS

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I N d E x O f S T O r I E S

EldErSpEAk 11

Source: New York Times (7.10.2008)

CoSy Club 15

Source: UnitingCare Australia and Inspiring Communities (2009) Building Belonging

GETTiNG To THE rEAl NEEdS 25

FollowiNG JupiTEr 27

bob’S lovE oF liTErATurE 35

viNyl plEASurES 39

THE CyCliNG Club 40

CookiNG HEr wAy bACk To HEAlTH 45

MrS GordoN’S HouSEHold 55

QuAliTy 62

EriCH ANd urSulA 69

ANoTHEr SoNG To SiNG 74

FriENdSHip 81

Kate Swaffer (2013) Saturday poem http://kateswaffer.com/2013/06/15/saturday-poem-friendship/ (Downloaded 18th June 2013)

GoiNG SwiMMiNGly 82

THE STrENGTH oF CoMMuNiTy 83

workiNG ToGETHEr 91

GrAduATioN 105

INd

Ex O

f ST

OrI

ES

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f O r E w O r d

This handbook is a gift for anyone working in services in the community that assist people to remain living at home and participating in community life. We hope that it will be a helpful tool to open up the world of possibilities for people needing assistance to stay in control and live a lifestyle in the community that is meaningful for them.

The first edition of this handbook Imagining a better life for older people was written for Home and Community Care (HACC) Coordinators in South Australia. A recent survey to those who had used this handbook returned the surprising result that over 50% used it to guide their daily practice. The Better Practice Project in SA has worked with these services over many years to shape an approach in HACC services that is strengths-based, person-centred, and recently more sharply focused on re-ablement.

The landscape of services for older people and people with disabilities in Australia is changing. HACC is moving to be the Commonwealth Home Support Program with a national focus. Home Care packages will all be delivered as consumer directed care from July 2015. My Aged Care and the Regional Assessment Services will be the first points of contact for many people seeking assistance. Some people with disabilities will be assisted through the National Disability Insurance Scheme (NDIS). In this changing landscape this handbook provides practical tools for anyone assisting people in the community to imagine possibilities for meaningful lives in the community, regardless of disability or frailty. Focused on the person’s goals, services will enable people to receive the assistance they need, taking into account their strengths, preferences and needs. This will lead to an individually tailored plan of assistance that blends paid supports, community resources and informal networks while supporting the person to be as independent as possible and in control of their lives.

Those working in community services set out each day to do their best for those they assist. However, they have many things to take into consideration along the way. Sometimes perceived obstacles and reporting demands can temporarily take our focus off what the person really wants and what will be beneficial for them. We hope that the resources in this handbook will contribute to ensuring our practice moves further towards the vision and aspirations of the people receiving services today, reflecting also the support we would want ourselves in the future. There is no doubt that expectations are already changing, and will continue to change into the future.

While the handbook has a series of modules that may at first appear to be sequential steps in planning home supports for people, they are actually more a number of considerations that need to be covered, not necessarily in the order presented. The handbook provides a range of thought starters, prompts, and

important issues to consider in the process of assisting people, not necessarily all the answers. Pointers are given to other references that may be of assistance.

The Handbook is based on an Appreciative Inquiry (AI) approach1 (see below for more information on AI). This asks: “what do we do well now and how can we do it better.” Or in the case of working with individuals,

“what are people’s strengths and capabilities, and how can we enhance them?” AI uses the four “D” cycle of: Discover, Dream, Design & Deliver.

This handbook follows the stages of Appreciative Inquiry, rather than the traditional case management steps of assessment, planning, implementation and review. In some ways these categories are very similar, but by changing the language and approach, we hope that this may give people new ways to look at their role in supporting people in the community.

This handbook also builds on the content of the Better Practice Project Handbook (2006)2 which explored the key principles that underpin a person-centred approach to working with older people. This provides backdrop for this latest edition of the handbook that is a more detailed practice guide.

We hope that the handbook will support you in your work and help you to:

• Focus on good questions that get to the heart of the issues and people’s real needs

• Help you to think “outside the square” in tricky situations

• Raise the bar about what is possible for people

• Keep a focus on the people you assist

• Develop the right relationship with the people you serve

• Help people to remain “in the driver’s seat”

• Tackle the hard issues that some of us do not like to think about, such as “what is best for our health & well-being?”

• Work at setting goals with people and celebrating their achievement

• Think about what it might take for services to no longer be needed.

Thank you to all of the practitioners who provided comments on the drafts and contributed their real life stories to illustrate key points. These stories have been used with permission.

Joyleen Thomas Manager, Better Practice Project

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PARADIGM 1: PROBLEM SOLVING PARADIGM 2: APPRECIATIVE INQUIRY

“Felt need”Identification of problem

Appreciating“Valuing the Best of What is”

Analysis of Causes Envisioning“What Might be”

Analysis of Possible Solutions Dialoguing“What Should Be”

Action PlanningInnovating

“What Will Be”Organizing is a mystery (infinite capacity)

to be embraced

Source: Cooperrider et al (2008) (5)

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Appreciative inquiry is a strengths-based approach to working with people that can be very helpful to the work of advisers in the human services area.

“Appreciative Inquiry (AI) is the cooperative co-evolutionary search for the best in people, their organisations, and the world around them. It involves the discovery of what gives “life” to a living system when it is most effective, alive, and constructively capable in economic, ecological and human terms. AI involves the art and practice of asking questions that strengthen the system’s capacity to apprehend, anticipate, and heighten positive potential.

All interventions focus on the speed of imagination and innovation instead of the negative, critical and spiraling diagnoses commonly used in organisations. The

discovery, dream, design and deliver model links the energy of the positive core to changes never thought possible.” 3

To apply Appreciative Inquiry, we use the “four D” cycle of: Discover, Dream, Design & Deliver.4 The Discovery phase explores ‘what currently is’ and, in particular, the ‘best of what is’. The Dream phase explores ‘what could be’. This is identifying and naming the desired results. Practical steps towards the exciting possibilities are identified in the Design phase. This is the conversion from ‘what might be’ to ‘what should be’. The fourth phase, Delivery, is the action phase, keeping in mind that arrangements are adjusted to fit the current needs, and are created to be sustainable.

The “four D” phases contrast with traditional “problem solving” approaches as seen in the table below:

A b O u T A p p r E C I A T I v E I N q u I r y

Bliss Brown, who has extensive experience in using AI, explains that:

“Deficit-based analysis, while powerful in diagnosis, tends to undermine human organizing and motivation, because it creates a sense of threat, separation, defensiveness and deference to expert hierarchies. Problem solving as a means of inspiring and sustaining human systems change is therefore limited.

In contrast, the underlying assumption of appreciative inquiry is that people and organisations are full of assets, capabilities, resources, and strengths that can be located, affirmed, leveraged and encouraged. There are a variety of AI models that guide how

Appreciative Inquiry is practiced but all of them are based on:

1. Choosing the positive as the focus of inquiry

2. Inquiring into stories of life-giving forces

3. Locating themes that appear in the stories and selecting topics for further inquiry

4. Creating shared images of a preferred future

5. Finding innovative ways to create that future.

Through constructive dialogue, trusted experience is shared, new possibilities imagined and new partnerships created to bring the desired future into being.”6

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A b O u T T h E h A N d b O O k

The “four D” phases of Appreciative Inquiry provide the structure for this handbook. In the Discover topics, you will find ideas that assist you to get to know the older person and to create a particular type of relationship with them. The Dream topics assist you to work with the older person and their family to imagine a positive future that is meaningful and sustainable. The Design topics provide ideas for you and the older person to work together and develop strategies for meeting their needs and building aspirations for a positive future. Finally, the Deliver topics puts things in place that ensure effective, quality responses by the service and by the person or family.

This handbook gives you a range of approaches to each topic – some are thought starters, others will give you a deeper appreciation of an issue, some are tools to assist you and others illustrate the topic with a story. Every person has a different learning style and will relate better to different parts to the material. The elements are included where they help enlighten the topic, so each element is not necessarily included in each topic.

You are encouraged to read the Handbook as you would a magazine, and use it in staff meetings, as orientation for new staff, to spark your own thinking or to follow up the references provided to further your own development.

ThE FOllOWIng FEATuREs ARE PROvIdEd In EACh TOPIC, WhERE RElEvAnT:

ThE APPRECIATIvE QuEsTIOn begins by considering the topic in a positive mode by asking you to think of a situation where you had a positive experience, and what you might learn from it and apply to your work with older people.

ThE PROvOCATIvE PROPOsITIOn bridges the best of what is and what might be, and captures the essence of this element in an adviser’s work. The proposition invites you to reflect on the possibilities in your work with an older person.

The RATIOnAlE outlines why this particular process or step is important.

The WORd dEFInITIOn sparks your thinking about what the words we use every day really mean. Unless otherwise referenced these come from the Macquarie Dictionary.

ThIngs TO COnsIdER provides a “checklist” of things to do and think about in relation to this topic when you are working with people in the community.

TOOls are some techniques you may find useful to delve more deeply into a particular topic.

The REsOuRCEs provider further reading and the evidence and research facts for this topic.

The ROlE ClARITy segment consists of some tips to provide role clarity for advisers in relation to this topic.

QuOTEs provide some inspiration from great thinkers over time!

The dIsCussIOn QuEsTIOn is a thought-starter for team meetings or discussions tackling some of the trickier issues relating to that topic.

ThE sTORIEs illustrate one or more of the principles and approaches explored in the Handbook.

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Disc

over

Identify what gives life.Appreciate the best of what is.

These two phrases are a contrast to what we would initially have in mind when going out to do an ‘assessment’. We usually think about identifying problems, needs and what is wrong with a person. This is also part of the discovery process, but first we focus on getting to know the person, their strengths and resources, and what is life-giving for them.

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Discover1 b E p r E p A r E d

Think about a time when you had prepared carefully before meeting someone for the first time. How did it help?

RationalePeople should not have to repeat information already provided to the service or referring agency. Workers need to give some thought to the issues that need to be covered in the first visit. Preparation is required for issues such as whether an interpreter is needed, or whether a family member/ advocate should be present.

Definition

Non-judgemental (adjective) Refraining from passing judgement

on someone.7

things to ConsiDeR

Gather any relevant background information from the referral source and screening process. Make sure that you:

• note demographic information and other details to ensure people do not have to provide the information again

•note the reason for referral

• take into account any considerations to ensure a successful first meeting, for example, communication (language, cognitive capacity, hearing); support needed (an advocate or interpreter); cultural factors

•respect confidentiality

Where appropriate, telephone the person to establish:

• who you are, where you are from and why you are phoning

• the person’s preferred method of contact (day, time, place)

• if the person would prefer to have a family member, friend or advocate present and ask who will arrange this

•if there is a need for an interpreter to be present

• if visiting home then clarify staff risks (such as dogs) and access.

1 – bE prEpA

rEd

the appReCiative Question the pRovoCative pRoposition

Workers will gather all relevant information before arranging the first visit, but will be careful not to pre-judge the situation.

2

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f I r S T d A T E :In many ways preparing for your first contact with a person is like

preparing for a first date! For example:

* you want to make a good impression

* there is careful thinking and planning about how you will approach it

* you put some effort into your personal preparation, such as your

appearance, equipment (cleaning your car?), purse, diary or pen

* you choose a suitable meeting place.

Remember that they may have already had a first date which may not

have been a good experience, or may have been great. You need to be

prepared for either!

Role ClaRityRemember that relationship building and empowering the person begins from the very first point of contact, including the initial phone call.

How do you engage with a person who is reluctant to receive support? What might you do if on initial contact they refuse to see you?

DisCussion Question

3

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Discover2d E v E l O p A p O w E r - w I T h r E l A T I O N S h I p

Think about a time when a professional made all the decisions without involving you. Contrast this with a relationship with a professional who involved you, shared information and where you made the final decisions.

RationaleA power-with relationship is the foundation for the person being decisively influential in how they are to be assisted.

Definition

Kendrick refers to a “power-with” relationship

as a “right relationship” and defines it as follows:

“Right relationship” is an ethical condition that exists between services and those they serve when the people served are seen and treated with appropriate respect, integrity and value and where they are enabled to be decisively influential in how they are to be assisted.”8

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Commenting on support for their neighbour: We have observed the adviser’s skill in patiently winning her trust and finally achieving her acceptance of support which is enabling her to continue to live safely in her home. We consider her patience and skills to have been

outstanding and worthy of recognition.

GTKY [Getting to know you] is not an optional extra. For a person living

with cognitive disabilities, as a result of dementia or stroke, getting to know the person is the key to successful support and assistance. For those who aspire to

be the assistants of the person living with dementia or stroke knowing the person

and their needs is crucial.11 Elspeth Stirling

Both the older person and the adviser bring knowledge, skills and experiences to the relationship. The adviser creates a relationship where they use their qualities like respect and honesty. They provide practical assistance when necessary. They make room for the older person to participate in the decisions that matter to them.

the appReCiative Question the pRovoCative pRoposition

4

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things to ConsiDeR

tools

Note that you cannot give power to a person, but you can avoid taking it away. Some ways to help build a positive relationship include:

1. hOW yOu EnTER ThE RElATIOnshIP:

• Arrive on time or let the person know if you are unavoidably late.

• Ensure the initial greeting is warm and welcoming.

• Introduce yourself and provide identification if necessary before entering the person’s home.

• Switch off your mobile phone and avoid other interruptions.

• Begin talking about something other than an assessment.

• Perceive the older person as having assets and skills. If they also have cognitive impairment, recognise that others around them also have assets and skills, and that the older person may still be able to express their choices and preferences.

2. ThE FEElIng TOnE OF ThE COnvERsATIOn:

•Adopt a tone that is enquiring and exploratory.

• Try to create a sense of ‘we are in this together’, but that the older person is ‘the driver’

• Avoid thinking about solutions as you listen to the person.

•Listen in a sensitive and non-intrusive manner.

• Speak in a conversational tone, avoid using jargon.

• Suspend your judgements and do not let assumptions get in the way.

• Let the person know you enjoy talking with them, it will help them relax.

• Involve family members or allies or advocates in the conversations where appropriate.

3. WhEn InFORmATIOn Is hElPFul:

• Provide relevant information about your service and those available from other agencies.

• Provide information in a way that enables them to make informed choices

• Ensure that if you are to continue contact, you have gained clear consent from the person or their representative to be involved with your program or to refer them to another service. Ensure the person understands their rights and responsibilities.

Use questioning to open the conversation to possibilities.

Try to ask more open questions than closed questions. An open question is one which cannot be answered with yes or no and which encourages a more detailed answer, for example:

“What are your feelings about this?” “ What are the advantages of doing things the way you have suggested?”

“What are the disadvantages?”

Avoid closed questions such as:

“Are you feeling depressed?” “Are you looking forward to Christmas?”

Another disadvantage of closed questioning is that the desired answer might be implied within the question and you might inadvertently steer the person to give an answer that they wouldn’t otherwise have given. An example of this would be:

“Do you want us to organise home care?” The implied expected answer here is quite clearly “yes”.An open question would be, “What has prompted you to contact our service?”

Try to frame questions in the positive:

“Tell me what a good day looks like for you”“What is your favourite activity of the week?”

AvOId BIAs

It is easy to make assumptions based on our experience. It is helpful to remember that everyone is a unique individual, with their own preferences and needs. A bias is any influence that changes an answer or an opinion from what it might have been without that influence. Ways you can avoid bias include:

• Be aware of your own opinions and perspectives and how these may be influencing your discussion.

• Do not express your own opinions about how the person should respond (e.g. I think everyone should have physiotherapy).

• Do not suggest answers even if the person wants your help. Help the person to think through the issue and use probing questions if necessary to encourage further conversation.

• Be patient – allow the person time to think and don’t jump in. Acknowledge that these are difficult issues.

5

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tools – ConTInueD

sIx TIPs FOR BuIldIng And mAInTAInIng RAPPORT9

Rapport building is the art of helping another person minimise their perceived difference between themself and yourself. This can be achieved by tactfully allowing the other party to see the common ground in your personality or point of view. Rapport happens at the subconscious level but here are a few ways that you can consciously help the process along. 1. rapport starts at the beginning. The best time to start building rapport is when you interact with a person for the first time. Then each subsequent time that you meet ensure that you start by re-establishing rapport. 2. give appreciation and importance to others Accept that the most important person in the world in the eyes of most people is themself. When interacting with someone else allow them to feel important. The easiest way to do this is to learn their name and use it often during your conversations. Recognise the person’s skills and capabilities and encourage them to take responsibility where they are comfortable to do so, showing appreciation for their contribution. In fact, why not make a habit of showing genuine appreciation for things well done in all interactions with others. 3. The skill of asking questions Remember that the person asking the questions is leading the direction of the conversation. Ask interesting questions that allow the other person to talk about themself or their interests and then listen attentively to what they are saying. 4. Active listening Listening is a skill and it’s easiest learned if you

develop the habit of being genuinely interested in other people. Allow the other person to do most of the talking unless they are specifically asking for your contribution or opinion. Give them positive feedback followed by non-threatening questions that allow them to expand on what they are saying. 5. Keep your ego under control Ego has been responsible for breaking rapport on more occasions than any other behaviour. Ego is a sign of low self-worth. If you develop a strong feeling of self-worth then you will not have the need to allow your ego to get in your way. Be willing to admit you are wrong when you are. Do so quickly and happily and gratefully acknowledge the other person’s role in helping you see your error. Be willing to allow others to take credit for your good ideas if it helps you achieve your desired end goal. Rather than argue for your point of view every time you are challenged, encourage the other person to express their point of view. If you do have to state an opposing point of view, acknowledge the value of their point of view first and then tactfully promote the additional benefits of your ideas. 6. Friendliness Nothing breeds friendliness like friendliness.

COnsIdER WhO TO PARTnER WIThIn the first instance, the guiding principle is that the partnership should be with the person. If the person has a cognitive impairment and/or a deteriorating condition, then early conversations could explore who could be the person’s ally so that the agency partners with both the person and their ally.

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Role ClaRityThe professional brings expertise, but does not act as ‘the expert with all the answers’. The professional is friendly, without being a friend. The professional asks questions, and brings a spirit of enquiry. They are neither an inquisitor nor an assessor. They are a facilitator and enabler, so that the person owns their own strengths and issues and owns the eventual solutions.

What could you think about, and do in a situation where you do not seem to be able to establish a positive relationship with a person? For example, what if they do not seem to trust you, or you disagree with their values and priorities, or even just that you have a personality clash?

Recognising power in another does not diminish your own

Joss Whedon

Kendrick, M. (2000) Some Initial Thoughts on Establishing ‘Right Relationship’ between Staff, Professionals, Service Organisations and the People they Assist.10

ResouRCes

DisCussion Question

6

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Discover3 A p p r E C I A T E T h E p E r S O N

Think about a time when you felt someone really understood you. What contributed to that understanding?

RationaleIn supporting people in the community we need to focus on the whole person, not just their deficits or needs. If we understand what is important to the person, we will ensure that if services are needed, those services support their lifestyle rather than the person fitting their life around the service. We also need to consider that the best support may not necessarily come from a service but from informal networks or community resources instead. Discovery is a process entered into with the person and their support networks.

Definition

Appreciate(verb) • to place a sufficiently high estimate on • to be sensible of the good qualities (of

a person, thing, or action); be pleased with or grateful for:

• to increase in value.

Identity(noun) • the state or fact of remaining the same

one, as under varying aspects or conditions • the condition of being oneself or itself,

and not another • condition, character, or distinguishing

features of person or things

things to ConsiDeR

Aspects such as the person’s history, work roles, family, interests and hobbies will all impact on how they might wish to be supported in the community. Explore these using open questions, such as ‘tell me about your family’.

the appReCiative Question the pRovoCative pRoposition

The adviser will understand enough about the person to be able to sensitively frame the discovery questions and gain a better understanding of the person’s strengths and support needs. Where little information is known, the adviser will look for visual cues in the home to gain an insight into the person and use these as conversation starters.

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3 – ApprECIA

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WhAT mATTERs TO mE 12

The following questions provide thought starters in helping you to get to know a person:

• If you were asked by a child to tell them about the most important thing you have learned in your life, what would you say?

• What was the best period of your life? Why?

• What was the hardest period of your life? Why? Did you know it at the time? What did you learn?

• What do you think was the best thing you ever did for someone else?

• If you could have anything in the world, what would it be?

• If you could give anything in the world to someone else, what would you give? To whom?

• What projects have given you the most pleasure?

• What have you worked hardest at (work, social causes, friendships, marriage, parenting)?

•What role does spirituality have in your life?

•What makes you feel most alive?

What common threads can you see in the above? This will highlight what is most important to you.

There will be situations in which the person you are supporting cannot easily respond to your questions, for example if they have dementia. You will then need to find out from those around them what is important to them.

Helen Sanderson13 uses a process called Appreciations to identify what is important to people.

Ask others significant to the person:

What is important to ………….?

What do you like and admire about ………….?

How do we best support ………………..?

Role ClaRityThe extent to which you explore a person’s history and interests will depend on the scope of your service and the type of support you are requesting. The more you are likely to be involved with the person over a longer term, the more important it is to understand the person’s identity.

“[The] sense of identity provides the ability to experience one’s

self as something that has continuity and sameness, and

to act accordingly.”Erik H. Erikson

ResouRCes

DisCussion Question

Helen Sanderson and Associates, (2007) Person Centred Thinking with Older People: Practicalities and Possibilities. 13

Sometimes it is important to try out the questions that we are asking other people on ourselves. Do you think it is important to understand what is important to you and what your goals and aspirations are, before asking other people the same questions?

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Discover4 d E m O N S T r A T E r E S p E C T

Definition

Respect (verb) (adjective) • esteem or deferential regard felt or shown • the condition of being esteemed or

honoured • to hold in esteem or honour • to show esteem, regard, or consideration for • to treat with consideration; refrain from

interfering with

RationaleThis is important because older people are at risk of ageism and discrimination. People who work in aged care generally do so because of a genuine respect for and affinity with older people. However sometimes we can unconsciously take on the prejudices of the wider community. This is reflected in the way we speak about older people or behave towards them, for example, speaking over people to their relatives, or using jargon or terms that may exclude or demean people.

the appReCiative Question the pRovoCative pRoposition

What does it feel like to be treated with dignity and respect? What are the particular behaviours that make you feel this way?

Services that support older people will make an extra effort to behave in a way that is positive and respectful of older people. This will enhance the person’s sense of self-worth and value in the eyes of others and the community generally.

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You can show respect if you:

• ask a person what they wish to be called (e.g. by their first name, nickname or Mr or Mrs …)

• speak in a normal voice – don’t yell or use a sing-song voice

• avoid using jargon – explain things in a way that is easy to understand

• don’t equate the person with their disability, for example the ‘stroke victim’ or ‘the dementias’

• speak directly to the person, even if they are unable to communicate, not to their relative, worker or interpreter

• be aware of your body language – keep an open posture, use eye contact appropriately (this may depend on the person’s cultural background), sit or stand at the person’s level

• treat others as you would expect to be treated yourself

• respect the privacy and specialness of the person’s home

things to ConsiDeR

MoRe aBout RespeCt

A group in Wisconsin comprising consumers, providers and case managers came together to define what they considered to be quality in a person-centred system.14 They came up with the acronym “RESPECT” which stood for:

Relationships

Empowerment

services individualised

Physical and mental health

Enhancement of image

Community

Tools

Role ClaRityWorking in partnership implies a relationship between individuals or groups that is characterised by mutual cooperation and responsibility, developed for the purpose of achieving a specified goal.

The level of knowledge and skills of the person and/or their carer needs to be taken into account. Some people are very capable and aware of the system, while others may require a lot more guidance and explanation. Keep this in mind when you communicate with people.

“Only those who respect the personality of others can be of real use to them.”

Albert Schweitzer

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DisCussion Question

What do you consider to be inappropriate behaviours when visiting the home of an older person? How would you deal with a situation where you observed a colleague, support worker or family member behaving in this way?

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E l d E r S p E A k From the New York Times

“Professionals call it elderspeak, the sweetly belittling form of address that has always rankled older people: the doctor who talks to their child rather than to them about their health, the store clerk who assumes that an older person does not know how to work a computer, or needs to be addressed slowly or in a loud voice. Then there are those who address any elderly person as “dear”.

“People think they’re being nice,” said Elvira Nagle, 83, of Dublin, Calif, “but when I hear it, it raises my hackles”.

Now studies are finding that the insults can have health consequences, especially if people mutely accept the attitudes behind them, said Beccy Levy, an associate professor of epidemiology and psychology at Yale University, who studies the health effects of such messages on elderly people.

“Those little insults can lead to more negative images of aging,” Dr. Levy said. “And those who have more negative images of aging have worse functional health over time, including lower rates of survival.”

In a long-term study of 660 people over age 50 in a small Ohio town, published in 2002, Dr. Levy and her fellow researchers found that those who had positive perceptions of aging lived an average of 7.5 years longer, a bigger increase than that associated with exercise or not smoking. The findings held up even when the researcher’s controlled for differences in the participants’ health conditions.

In her forthcoming study, Dr. Levy found that older people exposed to negative images of ageing, including words like “forgetful”, “feeble” and “shaky”, per- formed significantly worse on memory and balance tests; in previous experiments, they also showed higher levels of stress.

Despite such research, the worst offenders are often health care workers, said Kristine Williams, a nurse gerontologist and associate professor at the University of Kansas School of Nursing.

The researchers .... concluded that elderspeak sent a message that the patient was incompetent and begins a negative downward spiral for older persons, who react with decreased self-esteem, depression, withdrawal and the assumption of dependent behaviors.

Dr. Williams said health care workers often thought that using words like “dear” or “sweetie” conveyed that they cared and made them easier to understand. “But they don’t realize the implications,” she said, “that it’s also giving a message to older adults that they’re incompetent.”

Source: New York Times (7.10.2008)

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Discover5 f I N d S T r E N g T h S

RationaleStrengths-based practice assesses the inherent strengths of a person and their support network, and then builds on them. It utilises these strengths to address the particular issues they may be facing at the time.

It is about reframing perceptions to find the good in even the worst situation.

Think about the benefits of a strengths-based approach. Lyons lists the following advantages:15

• It is an empowering alternative to traditional approaches that focus only on deficits and problems.

• It avoids stigmatising language which people may begin to identify with, accept and feel helpless to change.

• It fosters hope by focusing on what has historically been helpful for the person, therefore using real successes to set the groundwork for realistic expectations.

• It provides an inventory of the positive building blocks that already exist to provide the foundation for growth and recovery.

• It reduces the power imbalance with the adviser by promoting the person as the expert in their own lives in relation to what will and won’t work in their situation.

•It places the adviser in the role of partner or guide.

• It involves the person’s networks and helps them to feel like an integral part of the process.

•It works!

Think about a situation where someone has acknowledged your strengths and capabilities.

How does that make you feel?

Advisers will understand and build on a person’s strengths when arranging the supports they need to remain at home. This will support recovery and empowerment, helping the person to feel more in control of their situation.

things to ConsiDeR

the appReCiative Question the pRovoCative pRoposition

Definition

Strength(noun) • an asset of special worth or utility

Recovery(noun) • restoration or return to health from

sickness; restoration or return to any former and better state or condition.16

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AssET BAsEd COmmunITy dEvElOPmEnT – PERsOnAl AssETs mAP 17

We can think about people’s gifts in three areas:

Gifts of the head – things I know something about and would enjoy talking about with others (eg. history, art, music, birds)

Gifts of the hands – things or skills I know how to do and would like to share with others (eg. carpentry, sports, gardening, cooking)

Gifts of the heart – things I care deeply about (eg. protection of the environment, civic life, children).

sTREngThs

Helen Kivnick and Eric Erikson18 have identified eight psycho-social themes that are a useful way of thinking about people’s strengths:

Hope and Faith

Willfulness, Independence and Control

Purposefulness, Pleasure and Imagination

Competence and Hard Work

Values and Sense of Self

Love and Friendship

Care and Productivity

Wisdom and Perspective

For example, a person who has developed the strength of willfulness to enable them to get through hard times may be described as having ‘challenging behaviours’ or being ‘resistant to services’. Understanding that part of a person’s identity and how it has developed may assist and adviser to draw on this strength to support greater independence and increase the person’s control over their supports.

St. Luke’s ‘Innovative Resources’ produce a set of Strengths Cards that could be of assistance in helping people to identify their strengths. You could show these cards to a person and ask them to pick the ones that best describe them. You could also use them in a family group or ‘Circles’ meetings and ask everyone to pick cards that describe themselves and the person in focus. There is also a set of cards called Age of Adventure which explores the ways in which older people are still engaged in their communities.

You can order these cards from St. Luke’s Innovative Resources www.innovativeresources.org 19

Role ClaRityAn important role for advisers is that of ‘reframing’. In this way issues or challenges can be re-interpreted as strengths.

If a situation or context is reframed, then another meaning or another sense is created. A situation can be seen in a new light. If we let limiting beliefs go, new conceptions and interpretation possibilities can develop.20

For example, a person may say: “I’m a terrible procrastinator – I just can’t make a decision”. You can re-frame that by saying: “You are obviously a very careful person and like to weigh up the pros and cons before making a decision. Can I help to provide you with more information to help make your decision?”

You can also elicit the person’s story by asking questions to gain more detail or depth, and check the meaning of what they are saying.

A second important role is to draw on the person’s strengths as a decision maker: they have, after all, been in control of their life decisions throughout their lives. We diminish a person’s autonomy if we make decisions for people.

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DisCussion Question

How do you respond to a situation where a person cannot identify their own strengths?

For example, if a person is depressed or grieving, he or she may only be able to see the world as ‘gloom and doom’. How might you overcome this barrier?

“If we perceive something as a liability, that’s the message we deliver to our brain. Then the brain produces states that make it a reality. If we change our frame of reference by looking at the same situation from a different point of view, we can change the way we respond in life. We can change our representation or perception

about anything and in a moment change our states and behaviors. This is what reframing is all about.” 21

Anthony Robbins

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C O S y C l u b Barb is a neighbourhood support worker who is employed by Uniting Care Wesley in Adelaide. A few years ago, Barb was asked to visit Colleanne, a woman in her early 80s who was experiencing considerable depression after the death of her husband. In her working life, Colleanne had worked with socially isolated people, but now she was the one who was lonely and felt useless. Colleanne made it clear to Barb that she believed that she had nothing much to look forward to, and frankly, didn’t know what life about at this stage. Now Barb is not really interested in offering services. Instead, Barb believes strongly that “everyone has a great story to tell and gifts to share. We just have to take the time to listen.”Barb noticed that Colleanne had half a dozen extremely fine knitted tea cosies on her sideboard. Not just ordinary tea cosies, but ones with knitted butterflies, bees, and gardens on them. About that time, the trendy T Bar had opened in Adelaide. Barb asked Colleanne if she could borrow a tea cosy to show to the T Bar, as she thought they might be interested in selling such wonderful tea cosies. Colleanne agreed, and the T Bar were delighted. They bought some and they sold really quickly. Barb went back to Colleanne, saying that she had found a market for the tea cosies.“Well and good” said Colleen, “but I don’t really need the money—is there some group in UnitingCare Wesley Adelaide which could do with the donation of the money?” Barb knew of another worker in the organisation, who was doing a fabulous project with women with an acquired brain injury.These women were getting together to create a quilt, with each panel made by an individual woman. The panels were well under way but the next step was a bit unclear. The worker was most appreciative of the prospect of the donation. Colleanne went to meet the women, and felt really inspired by what they were doing, and in great admiration of their courage in dealing with their disability.The tea cosies kept selling and Colleanne could not keep up. So Barb put the word out among some other older women who were experiencing social isolation. They became the Cosy Club. They got together once a month to swap patterns. Later they all occasionally joined in with the women with acquired brain injury.The Cosy Club has become a very active and committed group, supporting various projects and forming lasting friendships. Colleanne and Barb were later asked to present to a National Conference in Sydney to tell the story of the Cosy Club. Colleanne said that she had gone from having nothing to do, from feeling useless, to not having enough hours in the day.

Source: UnitingCare Australia & Inspiring Communities (2009)

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Discover6 I d E N T I f y N E T w O r k S

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RationaleRelationships have an enormous influence on all people’s happiness, health and well-being. The ageing process can provide both opportunities and challenges in maintaining important relationships.

An adviser should be aware of both the importance of assisting a person to preserve important relationships, and ensure that the process of service delivery does not damage or displace people who are important to the person being supported.

There are two important reasons for understanding the significant relationships in the lives of the people you are supporting:

1. To ensure that they are involved appropriately in the support plan for the person, and that the service does not take over roles that family or friends may be happy to fulfill.

2. To ensure that the service can support the maintenance of relationships that are important to the person, given the positive health benefits of doing so. This may range from supporting a spouse who is the main live-in support for a person, maintaining contact with a close friend, or continuing relationships with grandchildren.

When working with couples it is also important to consider their interdependence, and the importance of balancing the needs and wishes of both parties.

Think about the people who are important to you. If you had a crisis or health issue who would you turn to? Why?

Services will engage with relevant members of the person’s network (with their consent) and support the person to maintain important relationships.

things to ConsiDeR

the appReCiative Question the pRovoCative pRoposition

Definition

Relationship(noun) • A relationship can be a connection, association or involvement; a connection between

persons by blood or marriage; or an emotional or other connection between people. 22

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innEr ring

MiDDLE ring

OUTEr ring

RElATIOnshIP CIRClEs

You can map the most important relationships that people have by drawing concentric circles around the person. People in these circles both provide support to the person, and receive support from them. For most people there are no more than 8 or 9 close people in these circles, but they are crucial to the person’s life satisfaction and well-being. Talk to the person about who are in their ‘circles’.

innEr ring

You feel very close to these people. It is hard to imagine your life without them. Their presence is stable in your life over time. You share many kinds of support with them.

MiDDLE ring

You don’t feel as close to these people as those in the inner ring, but they are very important to you. Your closeness to these people is based on more than the roles they have. But you may not remain as close if either of you shifts out of your current role.

OUTEr ring

These people are important enough that you consider them part of your personal support system. These people provide support, but you are close to them as part of specific social roles. As those roles change your relationship is likely to change. 23

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Do you sometimes find people in the network of the person you are supporting that you do not consider helpful to the person? It may be an interfering neighbour or a relative who seems abusive or aggressive. How do you handle these situations? Are relationships ever all good or all bad? Under what circumstances should such relationships be preserved?

Role ClaRityAdvisers cannot be family therapists, but can respect the importance of relationships in facilitating support for a person. If the family relationships are complex or conflicting, you may want to consider a referral to a service that specialises in family counselling or mediation. Advisers can also be alert to people who seem lonely or isolated, and consider how they can help to build a person’s networks when planning their support.

“Let us be grateful to people who make us happy; they are the charming

gardeners who make our souls blossom.” Marcel Proust.

DisCussion Question

Hutia te rito o te harakeke

Kei hea te komako e ko?Ki mai ki ahau

He aha te mea nui o tenei ao?

Maku e ki atuHe Tangata!He Tangata!He Tangata!

If the centre of the flax is pulled out (and the flax dies) Where will the Bellbird sing? If you were to ask me What is the most important thing in the world? I would reply It is People! It is People! It is People!

a MaoRi pRoveRB – WhaKatauKi 24

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Discover7 u N d E r S T A N d d I v E r S I T y

Think about the elements of your background and upbringing that make you unique. How do you remain connected to the traditions and beliefs that are important to you?

Advisers will be sensitive to the cultural identity and background of the person being supported, and how this impacts on his or her ability to communicate, preferences for support, and the role of the family and informal support network. Advisers will also consider the cultural impact on food choices, appropriate leisure activities and the role of spiritual support.

the appReCiative Question the pRovoCative pRoposition

RationaleAdvisers need to be aware of how their own cultural background and values influence their preferences and decision-making, and the importance of providing culturally sensitive services in order to effectively meet the needs of people from other cultures. Services must be provided without discrimination and with the appropriate supports (such as interpreters).

Definition

Culture(noun)• The totality of socially transmitted

behaviour patterns, arts, beliefs, institutions, and all other products of human work and thought.

Discrimination(noun) • Treatment or consideration of, or making

a distinction in favour of or against, a person or thing based on the group, class, or category to which that person or thing belongs rather than on individual merit. 25

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ThInKIng ABOuT CulTuRAlly APPROPRIATE suPPORT

The following is a list of considerations when providing culturally appropriate support:26

COmmunICATIOn

• Effective communication is crucial to the physical and emotional well-being of the person being supported.

• Provide information in the person’s language – written or verbal -depending on their literacy.

InTERPRETIng

• Use professional interpreting and translating services (do not rely on family and friends), especially when conducting assessments and care planning. An interpreter is crucial if informed consent is required.

usE OF BIlInguAl sTAFF

• This is to be encouraged but always check the person’s preferences (it may not always be appropriate in small communities).

• Explore the availability of bilingual volunteers to provide social support.

hEAlTh And PERsOnAl CARE

• Ensure all health and personal care plans and reviews identify and support the cultural, linguistic and spiritual needs of care recipients.

• Provide information about health and personal care services - including information on specific procedures that may be unfamiliar to care recipients - in the preferred language of care recipients and their families.

• Consult with care recipients and their families on the influence of culture and religion on health and personal care services.

• A discussion of diagnosis and prognosis is appreciated but balance this with legal requirements around issues of informed consent.

• Establish the cultural and religious impact on the acceptability of certain treatments and medications.

• Ensure family members’ roles in decision-making about care have been clearly established and documented.

• Ensure an effective communication strategy is in place to address medical and other types of emergencies for care recipients from culturally and linguistically diverse backgrounds.

• Consider the cultural, linguistic and spiritual needs of care recipients when referrals are made to external health service providers, and ensure they use accredited interpreting services as required.

• Provide care recipients with a choice of bilingual health practitioners and pharmacists where possible.

• Support your care recipients’ right to access complementary or traditional therapies, and assist them to make informed choices.

• Ensure that the staff members responsible for the provision of health and personal care have been trained in cultural awareness, appropriate communication, and the correct use of telephone and on-site interpreting services.

dEmEnTIA

• Ensure that people with dementia and their families are aware of the dementia support services available through Alzheimer’s Australia.

CulTuRAl AWAREnEss

• Understand how a person’s culture may inform their values, behaviours, beliefs and assumptions.

• Utilise the resources available to understand more about the particular culture of the person you are working with, for example the Centre for Cultural Diversity.

dIsCRImInATIOn

• Be aware of both the moral and the legal obligations to avoid discrimination on the grounds of the culture or language of a person.

• Although there may be culturally specific aged care services, everyone has the right to access mainstream services.

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DisCussion Question

ThInKIng ABOuT ABORIgInAl And TORREs sTRAIT IslAndER EldERs27

While some of these notes and concepts apply to all service users, they are of particular importance to indigenous people. There are specific cultural factors to be considered when working with Indigenous elders and their communities:

• The person you are working with has a choice in deciding which personal information is provided. Respect that it is their life story that you are learning about.

•Don’t ask for information that you don’t actually need to know.

•Don’t make assumptions.

• The right environment is crucial. Take care that you meld into the person’s choice of environment so that they can take the lead.

• Work with the person and their family to maintain as much independence as possible. Show respect for the person’s family.

• If possible, buddy up with a worker who has knowledge and experience of the person’s culture.

• Don’t tell the person what you think they need (i.e. don’t put words into his or her mouth).

• Use simple language – avoid jargon and acronyms.

• Remember that you are having a conversation, not conducting an interrogation!

Remember that many Indigenous older people have experienced significant losses and traumas, and it is important that the service does not inadvertently contribute to any further losses.

www.culturaldiversity.com.au

Benevolent Society of NSW. Working with older Aboriginal and Torres Strait Islander people - research to practice briefing.28

How do you approach a situation where you are confronted with cultural practices that you do not necessarily agree with?

“If we spent as much time trying to understand behaviour as we

spend trying to manage or control it, we might discover that what lies behind it is a genuine attempt to

communicate.”M. Goldsmith 29

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Think about a time when you were lacking something important in your life. How did you identify that need? What did others do that was helpful to you?

While advisers will take a strengths-based approach to Discovery, they will also identify the important needs of the person, both urgent and fundamental. Through conversation with the person and their network, the adviser will identify which needs should be met in order for the person to live well and have a positive future.

the appReCiative Question the pRovoCative pRoposition

RationaleIt is important for the adviser to identify with the service user their most fundamental and urgent needs. These are the needs that if met, would allow other needs to be met. They are different from ‘wants’. The services or supports provided should address these most fundamental and urgent needs in order to be relevant to the person. The service provision should be in the amount needed, not too much or too little, and delivered in a timely manner.

It is also important to be aware of those needs that are universal to all people and those that are specific to a person’s life experiences, frailty or impairment. Particular experiences of discrimination and loss may have an impact that creates a particular need. For example, a person who has moved around frequently may have a greater need for security and stability.

It is also important to recognise that experiences of loss or ageism may impact on a person’s self-confidence and self-esteem, and their ability or willingness to express their needs. Some people may also have limited experiences of potential alternatives, and as a result, a person may express a ‘want’ for what they know is available. Therefore, needs do not always equate with a person’s request, and advisers require the skill of helping a person to discern their real and fundamental needs.

No service can or should address all the needs of a person. Services should be clear about their scope and concentrate on competently addressing needs within that area. However, they should be aware of the other needs of the person and make referrals and/or advocate for these to be addressed by others.

Definition

Need(verb) (noun) • a lack of something wanted or deemed necessary 30

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Definition

Vulnerable(adjective) • susceptible to being wounded; liable to physical hurt. • not protected against emotional hurt; highly sensitive. • exposed to the risk of abuse or neglect, as a child, an aged person, a disabled

person, etc., and therefore requiring special government support and protection.

To help discern a person’s needs:

• Initially encourage the person to state what they believe they need, trying to frame it in the positive (e.g. “what would be helpful to your situation at present?” rather than “what is wrong with you?”)

•Check the accuracy of your understanding

• Explore the needs as seen by others, e.g. “what does your doctor think?”, or by asking others who are present

• Check with the person as to whether they agree with the views expressed by others

• You may wish to make suggestions based on your observations or knowledge of the situation. These suggestions may explore needs that are harder for the person to identify or discuss (e.g. “how do you feel about being on your own here?”, or “how do you manage with your garden?”)

•The exploration of specific needs around particular conditions may require further discussion at a later visit, or the involvement of a person with specialist skills (e.g. issues of dementia, mental health or chronic illness).

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ImPORTAnT TO And ImPORTAnT FOr

Helen Sanderson draws the important distinction between what’s important TO a person (what makes them happy, content and fulfilled) from what’s important FOR a person (for their health and safety, their perception of being valued). It is important when discerning needs to find a good balance between the two perspectives.31

hEAlTh And WEll-BEIng

Advisers may find themselves needing to raise issues that are ‘important for’ people, but which they may not initiate discussion about. The following checklist will help you think about areas that may need to be discussed to ensure a person can be healthy and safe at home.

hEAlTh IssuEs ChECKlIsT

While taking a wellness focus, advisers should also consider the possibility of the following issues that may impact on a person’s health and well-being and help to plan ways of addressing these issues:

•Home safety

•Nutrition and hydration

•Dental health

•Medications

•Exercise and mobility

•Depression and anxiety

•Dementia

•Falls prevention

•Emotional and spiritual needs

•Isolation and loneliness

•Family stress

•Chronic disease

dIsTInguIsh BETWEEn A nEEd And A REsPOnsE TO A nEEd

We often confuse a need with what might be a common response to that need. For example, a person does not need a wheelchair, but may have a need to move around. If a person has some ability to walk, then this need may be met in various ways, including assistance to walk, physical therapy to strengthen mobility, a wheelchair or a scooter.

FIvE Whys

One way to identify needs is to use the “Five Whys” exercise. Keep asking the questions “why?” until you get down to the real needs. For example, if a person is identified as needing a “day program”, ask “why” five times.

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Why? Because she has become isolated

Why? Because she cannot drive a car

Why? Because her husband recently died and he used to drive her everywhere

Why can she not go to the places she used to go with her husband? Because she cannot get there and does not feel comfortable going alone

Why does she not feel comfortable?

You can see that we have now identified a number of needs that have little to do with going to a day program. A need for autonomy through access to transport, a need for belonging and acceptance, and perhaps a spiritual need relating to her feelings of grief for her husband. A day program may be able to meet some of these needs, but there may also be a range of other possible responses that are more relevant, such as taxi vouchers or a volunteer driver to take her to visit old friends, a regular lunch with some friends who have also been widowed, etc.

FRAmEWORKs TO ThInK ABOuT nEEds

Bradshaw32 identifies four main categories of need:

1. Normative need is need which is identified according to a norm (or set standard); such norms are generally set by experts. Benefit levels, for example, or building standards, have to be determined according to some criterion.

2. Comparative need concerns problems which emerge by comparison with others who are not in need. One of the most common uses of this approach has been the comparison of social problems in different areas in order to determine which areas are most deprived.

3. Felt need is need which people feel - that is, need from the perspective of the people who have it.

4. Expressed need is the need which they say they have. People can feel need which they do not express and they can express needs they do not feel. This may occur when a person says what they think another person wants to hear.

unIvERsAl humAn nEEds

Wolfensberger has identified ten areas of human need that are common for nearly everyone.33

1. Bodily well-being

2. Sense of personal security and safety

3. Belonging to and with others

4. Valued acceptance by, esteem, respect and love from others

5. Sexual relations, intimacy and giving and receiving affection

6. Mental integrity and stability

7. Autonomy, independence and control

8. Aesthetic and higher cognitive needs

9. Spiritual needs

10. Happiness, contentment, felicity

nEEds RElATEd TO hOmE

Based on interviews with older people, De Jonge et al34 found that there were five important features of home. These also indicate areas of need:

•to have valued roles at home

• to have control over one’s own home environment

• to be connected to neighbours and other typical community resources like transport, shops and clubs

• to feel comfortable within one’s home and surrounds like the garden and neighbourhood

• to be at home with all the memories that were created at home.

nEEds RElATEd TO lOnElInEss

Stanley35 identified five forms of loneliness: private, relational, connectedness, temporal, readjustment. Needs related to loneliness will vary depending on the type of loneliness. A person can be alone but not lonely. On the other hand they could be surrounded by people but still feel lonely as they have not real connection to the people they are with.

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g E T T I N g T O T h E r E A l N E E d SKeith is an 86 year old man who lived alone in his own home for 10 years following his wife’s death from cancer. He had a stroke some 5 years ago that meant he needed to walk with a stick and struggled with verbal communication. Despite this he continued to live at home and tend his beautiful garden that he had built up over the entire period of married life. He has a close relationship with his two daughters and his three grandchildren and 7 great grand children. Highlights of his year include taking part in the ANZAC Day parade and having a family Christmas picnic each Christmas day in the parklands. He has a great love of the outdoors and in the past taught several pet budgies to talk and sing songs. He was an accomplished tenor, played the mouth organ and before his retirement when he turned 65 years had been a manager in a bottle washing business. He is a member of the RSL and served with the army in the Second World War

How do you raise those tricky areas that people may not have described as a need, for example continence issues, memory loss, mental health issues? What about observations you have made about what might be ‘important for’ the person, such as home safety issues, or personal habits that are damaging to their health?

Role ClaRityThe adviser’s role in understanding people’s real needs goes beyond just asking what the person wants, for the many reasons outlined in this topic. The adviser requires skills in understanding the ageing process, as well as the ability to observe and sensitively uncover deeper needs. This will ensure that the supports provided are the most relevant to the person’s situation and most likely to help them remain at home and as independent as possible.

“Everybody needs beauty as well as bread, places to play in and pray in where nature may heal and cheer and give

strength to the body and soul.” John Muir

DisCussion Questions

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along with two of his 4 brothers all now deceased. He has one surviving sister aged 83 years whom he sees regularly.

Keith had a fall in the garden injuring his hip, struggled to get inside his house but before he could call for assistance fell again and could not get up. His daughter found him on the floor on driving to the house when he did not answer his telephone. He had broken his hip badly and required hospitalisation. Despite hip surgery he was unable to weight bear. An Aged Care Assessment Team classified him as high care and hospital staff advised that he would need nursing home care. He became very depressed and refused to have physiotherapy treatment and saw himself at the end of his life.

His younger daughter was inspirational challenging her father and the service system to see a better life than a nursing home placement which he clearly did not want. She recognised his need to spend time in the outdoors and for companionship at the same time as appreciating the reality that he would not be able to continue to live in his own home without a carer. She understood his real needs as well as being able to recognise the needs arising from his disabilities caused by the stroke and fractured hip. She and her partner took him to live with them in their home in the Adelaide Hills and organised the necessary equipment and home modifications so that he did not need to stay longer in respite care while they waited for in home care support from the community service agency. With his daughter’s persuasion he accepted a visiting physiotherapy service and with assistance over several months was able to transfer to and from his wheelchair. He now spends much time in the garden, visits family and old friends with his daughter in a big old Mercedes and took part in the Anzac Day parade with his daughter’s partner’s assistance. His other daughter also stays with him to give his carer daughter and her partner a chance to take a break with trips away for short holidays or to visit their own daughter in Melbourne. He has a modified but enjoyable life style with many of the things important to him still part of his life even though he was not able to return to his own home and garden.

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f O l l O w I N g J u p I T E rJupiter the dog had been a gift from the children to their parents to “commiserate” (or, in fact, was it to celebrate?) their parents becoming “empty nesters” as the last of the children moved out of home.

The parents, Sophia and Gerald, had Jupiter throughout their last years working and into retirement. Jupiter even destroyed the shoes that Sophia had intended to wear to her retirement party. Jupiter quickly became part of the household and the three of them had a daily pattern of existence mapped that they walked through every day.

When Gerald passed away, Sophia felt lost and distraught. How could she make sense of a world without the two of them in it together? She lacked motivation and daily things became unimportant- “why cook when it’s just me?” or “why clean? There’s no one here to notice?”

Everything became just a little duller.

Sophia, at the urging of her children, sought help. She needed a new routine, a new way of making it through this unchartered life.

What the support worker quickly noticed was that Sophia still cared for Jupiter, sometimes even more than her own needs. Needing to feed Jupiter always got Sophia out of bed. Jupiter needed Sophia, and it seemed Sophia needed Jupiter too.

With some encouragement and after taking Jupiter on his first few outings with a volunteer, Sophia began to walk Jupiter daily. She would walk down to the local park (which allowed dogs off the lead to Jupiter’s pure bounding joy). There she met many other dog lovers walking their dogs and she began to form friendships. On Thursdays they’d visit the local shops and Sophia would plan the week out with meals (and of course treats). The butcher always gave Jupiter a meaty treat too.

On even the saddest and darkest of days for Sophia, Jupiter would be waiting by the door for his daily walk and would not be ignored. Gradually Sophia realised that by helping Jupiter, she was, in fact, helping herself.

FOOd FOR ThOughT:• You are working with Sophia and you

discover a series of beautiful mosaic pieces in her home. She mentions that she had always wondered about creating her own mosaic. How could you encourage and support this idea to find another interest for her?

• Would you communicate with Sophia’s children about what Sophia is up to? Why or why not? If yes, what would be the best way for you to communicate?

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Drea

mIdentify what might be. have a vision for the future.

Planning supports for people in the community should be based on what is important to them, both now and in the future. The Dream stage is about encouraging the person to think about the future, based on what they have enjoyed or accomplished in the past, or what they imagine for the future, rather than focusing on perhaps a recent event that has led them to need your support. The services or informal supports can then be designed in the next stage to support that lifestyle.

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Think about a time when you were able to articulate to someone your dreams in life and what was important to you. What happened as a result of that?

The person will be decidedly influential in planning the supports they require to be able to live a full and purposeful life in the community. They will be encouraged to talk about their aspirations.

the appReCiative Question the pRovoCative pRoposition

RationaleNow that you have come to know the person and built rapport, it is important to develop with the person a description of a desirable future that builds on this knowledge in order to identify their goals and preferences.

lIFE PuRPOsE 36

Living a life of passion and significance requires knowing what your definite purpose in life is. Defining and living your life purpose gives you an overwhelming sense of fulfillment and meaning to your existence because it provides a way for you to use your values and passions and directs them towards a meaningful objective. Your life purpose is the essence of who you are as a person. Once you know what your purpose in life is, you will be able to wake up each morning knowing that every action that you take that day will move you one step closer towards your ultimate purpose in life.

ThE COMpOnEnTs OF LiFE pUrpOsE

Often people confuse their life purpose with their profession or their various roles in life (i.e. mother, father, husband, wife, etc.). While your profession or role can serve as the vehicle through which you can reach your life purpose, your professional title or role is not in and of itself your purpose in life. Knowing what your purpose in life is motivates you towards ultimate achievement and enables you to live a passionate life. Life purpose is made

up of two important components: Core values and associated passions. To find your purpose, use the following formula:

CORE vAluEs + AssOCIATEd PAssIOns

= PuRPOsE

CORE vAluEs

These are the fundamentally beliefs, morals, and standards that define you as a person and which guide your behavior. While other aspects of your life change, your core set of values do not change. Core values are what you tell a person who asks you, “What do you stand for in your life?”

AssOCIATEd PAssIOns

Associated passions are the vehicles by which you can fully express and share your core values. They are the things that you love to do in life. They can also be specific talents, skills and abilities that you possess which fully express the associated value. They can also include things that you have never tried before, but have a desire to experience someday.

Dream

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Being frail or having a disability does not mean that life no longer has purpose. However, we may need to set up ongoing assistance for people to live out their core values and pursue their passions.

ThInK TyPICAl

Consider a positive future that is based on typical places, activities, routines with people who are not paid to be in the person’s life. In this way, what is imagined is an ordinary life (even though it might take extraordinary efforts) rather than a service life.37

BEgIn A lIFEsTylE PlAn

The completion of an assessment form or even most care planning forms is not necessarily a plan. Planning needs to be a two-way conversation about both dreams and aspirations, and the very practical issues that need to be addressed for a person to live a good life at home. You do not have to utilise a particular planning tool, but it may be

a helpful way to guide the process and provide prompts about areas to consider. Visual aids (using whiteboards or diagrams) may also assist. You may also wish to invite other people to be part of the planning process if the person would like to involve them. A detailed planning session is unlikely to happen at the first visit – it requires the building of rapport and discovering more about the person. The plan should be individually tailored to the person – no two plans should look alike.

PlAn IndIvIduAlIsEd suPPORTs

There are many different tools that have been developed to assist advisers with the process of person-centred planning. Many of these were initially developed in the disability sector, and some have been adapted to working with older people. Helen Sanderson and Associates have developed some very useful tools for person-centred thinking with older people (See the framework below for an example).

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tools

Appreciative questions that explore from ‘who is the person’ to ‘what is a positive future’

The following questions, developed by Sanderson & Associates, can help you to begin to develop a plan with a person.38

QuEsTIOn AddITIOnAl PROmPT QuEsTIOn How did you get where you are today? Tell me about yourself?

How are you today?

Tell me what you are proud of, like your family or your work?

Who was in your life in the past?Who is in your life now?What about where you live? What time do you spend with others?

What time do you spend on your own?How do you spend your time? What is a good day for you?

What is a bad day for you?What ideas do you have about how you would like your life to be?

What matters to you?

What is important to you?

What do you miss that you do not do any more? What would it take to get that back on track?

Is there something you have always wanted to do but never had the opportunity?

How would you like your week to be?

What do you want to change about your life? What do you want to keep the same?

What are your “must haves” and what are your “like to haves”?What is, or could get in the way? How is your health?

Is there anything you need to leave or grieve for?

What are you worried about?What or who could help?What would life be like if all this went well? Where do you want to be in 12 months time?What are you needing support with? Do you need more information about what is available?

What have others suggested may be helpful? Is that your view?

What role do you wish to take in arranging this support?

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Dr. Helen Kivnick has developed an approach known as “Vital Involvement in Old Age”.39 This focuses on the strengths and resources that older people have that can be utilised to address the issues they may face in relation to frailty or ill health. Rather than focusing on problems, which may actually exacerbate ill health, this approach utilises people’s strengths to enhance their quality of life. Vital involvement is a person’s meaningful engagement with the world, where people use their capacities and make contributions of value.

The figure below describes domains of life and health in terms of two axes. The first axis is a continuum from negative to positive - from weakness, illness and problems at one end, to strengths, wellness and assets at the other.

The second axis is the continuum from an individual to their environment.

So Quadrant 1 would include individual symptoms and conditions (such as disability, disease or injury). Quadrant 2 would include individual strengths and assets (such as reasonable stamina, optimism, lifelong engagement in physical exercise). Quadrant 3 includes environmental strengths and supports (such as social networks, available transport, accessible housing, and community resources) and Quadrant 4 includes environmental obstacles and stressors (such as the ill health of a carer, extremes of weather, lack of needed equipment in the home).

The approach looks at how personal and environmental strengths (Quadrant 3 & 4) can be mobilized to address the problems, risks and barriers (Quadrant 1 & 2).

Source: Kivnick & Stoffel (2001) (45)

l I f E A N d h E A l T h d O m A I N S

problEMSriSkS

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pErSoN

ENviroNMENT

pErsOnAL prOBLEMs:

risKs

pErsOnAL sTrEngThs:sUppOrTs

EnVirOnMEnTAL prOBLEMs:

risKs

EnVirOnMEnTAL sTrEngThs:sUppOrTs

“The purpose of life is a life of purpose.”

Robert Byrne

Have you ever had a situation where it was difficult to engage a person or their networks in a planning process? How did you describe the benefits of planning to a person?

Role ClaRityIn the process of planning, the role of the adviser is one of facilitation, which literally means to “make things easier” for a person. You do this by asking the right questions and leading people through a process that enables them to discover what their goals and preferences are, and what sort of support will help them to live a full life. You may also provide information about what is possible, or encourage people to “think outside of the square”.

DisCussion Question

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Dream10S T r E N g T h E N A N d / O r I d E N T I f y N E w v A l u E d r O l E S

Think about the most important roles you have in your life. What privileges do these roles bring? What responsibilities do they carry?

The adviser recognises the importance of valued roles by planning to defend, maintain and enhance existing valued roles, as well as finding new valued roles in the community that are consistent with the service user’s identity, age and gender.

the appReCiative Question the pRovoCative pRoposition

RationaleRoles provide a place for people in society. It is more likely that those with positive roles will be afforded other “good things” in life such as dignity and purpose. Roles will influence many other aspects of a person’s life. Without positive roles, service recipients can easily fall into negative stereotypes of older people such as old age being a second childhood or an older person burdening society.

Research indicates that being productive and contributing to the community are important for older people.40

Definition

Social Role(noun) • A social role may be viewed as

a combination of behaviours, functions, relationships, privileges, duties and responsibilities that are socially defined, are widely understood and recognised within a society, and are characteristic and expected of a person who occupies a particular position within a social system.41

Ikigai • Japanese term “that which most makes

one’s life seem worth living” 42

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Helping people to plan to be in valued roles means:43

• pursuing valued roles and friendships within the community as a priority, rather than just doing activities and filling time

• pursuing the most valued roles that are realistically achievable based on each person’s interests

• setting standards high, stretching to accomplish more and not settling for what is easy or convenient

• challenging negative stereotypes and prejudices by proving them wrong through practical example

• pursuing social inclusion and individualised support rather than segregation and group activities

• helping people to have meaningful lives that enable them to pursue their interests and passions

• having high expectations of what is possible for people, despite frailty, disability or cognitive impairment

• helping people to make their own decisions, maximising their independence and autonomy

• talking about the barriers and finding ways to overcome them

• being an empowered and valued part of the community, not just being physically present.

Valued roles for all: the keys to a good life44 is an excellent practical resource. It can be downloaded from the Better Practice Project website.

What valued roles can you imagine for people who are restricted in their physical and/or cognitive capacity?

things to ConsiDeR

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Think about how you might support a person’s current roles, or find new roles in the areas of:

•relationships – parent, sibling, grandparent, friend, neighbour

•work or volunteering

•education – teacher, student or mentor

•recreation and leisure, hobbies – bowler, patchworker, swimmer, art appreciator

•public life – citizen, voter, activist, council member

•religious or belief systems – congregation member, organist, philosopher.

Remember valued roles are possible even when someone’s physical or cognitive abilities are quite restricted. There are ‘being’ roles as well as ‘doing’ roles. For example, the roles of a returned soldier or ex-teacher are ‘being’ roles. ‘Being’ roles require less present action.

Some roles will have a greater influence on a person’s life than other roles, for example the role of ‘club member’ could have a greater impact on identity than the role of ‘shopper’.

We also need to be careful to avoid projecting negative roles onto older people, such as the common child roles, sickness roles, or the role of being incompetent or a burden.

Roles are conveyed through a number of means including the places where people are seen, the people and groups they mix with, the language used to talk about (or with) them, the activities they participate in and even their personal appearance.

“All the world is a stage, and all the men and women merely players. They have their exits and entrances; each man (sic) in his time plays many parts.”

William Shakespeare34

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b O b ’ S l O v E O f l I T E r A T u r EBob is an 80 year old man who can talk to anyone and make them laugh. He is always the life of the party and popular among his friends.

Bob was an English teacher and enjoyed reading and discussing classical literature. In the past, he would often host book clubs at his house (and as an added bonus, he would bake delicious muffins for everyone who attended).

Bob loved walking into town to do his shopping. He liked to stop in and talk to a number of shop owners along the way, and would make an effort to say hello to everyone he passed on his walk. He would buy his flour from the baker, his eggs from a lady who lived off of the main street, his berries from the green grocer and anything else he needed from the supermarket.When Bob injured his hip he couldn’t walk as far and could no longer walk into town. His daughter began to do his shopping for him. She would drop it into the house and sometimes be his only contact for the day. She didn’t always buy the fresh berries for his muffins and the eggs weren’t the same from the supermarket, but he would thank her kindly and mask his sad and helpless feelings.Because Bob was so talkative and loved people, his limited contact with his community made him depressed. He didn’t even feel the need to get dressed some days, because he knew he would not see anybody, even if he did. Some of Bob’s contacts had faded because he was not able to drop in and say hello as he usually would. Even Bob’s ability to invite people to book group was hindered by his recent lack of mobility.After discussing Bob’s loneliness, a community liaison worker suggested to Bob that he volunteer at the local Op shop. It was on the main street and he could catch the bus there. Luckily, his house was just across from a bus stop so transportation would not be an issue. After communicating his ability to talk and do math, along with his limited use of his legs, Bob was given one shift a week where he could sit behind the till and put through purchases. He would engage all of the customers in conversation and he even invited some of the other volunteers over for muffins and book night.Bob often waited for the bus home turning the pages of a second hand book that he had found during the day.While Bob could no longer take long walks to the shop, he was able to travel by public bus. He was able to volunteer and gain the contact and connections with others that he required to feel happy. He even extended his book collection, which gave him plenty to do on his days off.

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Have you ever made a New Year’s resolution to spend more time with your family or friends, or to make contact with people you have lost touch with? How did you go about doing that? What were the benefits?

In the planning process, advisers will look at the important relationships and networks that have been identified in the discovery process. They will work with the person to identify how the relationship can be supported, valued and developed, and the relevant people involved. If loneliness or isolation is identified as an issue, the adviser will help the person to identify opportunities for social interaction based on the person’s interests. Where the person has a carer living with them or a person who is very involved in their care, there is also a need to plan how to support that person in their caring role.

the appReCiative Question the pRovoCative pRoposition

RationalePeople’s networks may naturally decline as they age, when friends die or transport and mobility make it more difficult to keep in touch. This does not mean that relationships are any less important for older people. We know that:

“…good relationships do more than make us happy; they make us healthy. Scientists have demonstrated that being in close, positive relationships can improve physical health by countering stress and producing feelings of calm. These relationships can even prevent chronic health conditions in later life.” 45

Support from unpaid relationships is also crucial in helping many older people remain at home. They may be family members or friends living with the person, or coming in regularly to provide support or check on the person. It is important that the service does not take over what a family member, neighbour or friend may be happy to do, but also that they plan support that will help the person to maintain their role.

Definition

Belonging(verb) • acceptance as a natural member

or part 46

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Build on the relationship circles (see Topic 6). Imagine who could be brought into the inner circles of the person and who else could be added to all circles.

Explore ways that family members and friends can be involved. Think of things that the person and others can do together. Be sure to include the person in all family occasions.

Stay in touch - Don’t leave it too long to contact friends. Sometimes it just takes a phone call to help you feel connected again.

suPPORTIng CARERs

The Carer Recognition Act (2010)47 includes The Statement for Australia’s Carers which provides guidance to all organisations on their obligations to those who provide personal care, support and assistance to another individual in need of support.

1. All carers should have the same rights, choices and opportunities as other Australians, regardless of age, race, sex, disability, sexuality, religious or political beliefs, Aboriginal or Torres Strait Islander heritage, cultural or linguistic differences, socioeconomic status or locality.

2. Children and young people who are carers should have the same rights as all children and young people and should be supported to reach their full potential.

3. The valuable social and economic contribution that carers make to society should be recognised and supported.

4. Carers should be supported to enjoy optimum health and social wellbeing and to participate in family, social and community life.

5. Carers should be acknowledged as individuals with their own needs within and beyond the caring role.

6. The relationship between carers and the persons for whom they care should be recognised and respected.

7. Carers should be considered as partners with other care providers in the provision of care, acknowledging the unique knowledge and experience of carers.

8. Carers should be treated with dignity and respect.

9. Carers should be supported to achieve greater economic wellbeing and sustainability and, where appropriate, should have opportunities to participate in employment and education.

10. Support for carers should be timely, responsive, appropriate and accessible.

Carer’s Australia48 is the peak body for carers and this is their advice to help support carers:

• Share the care with other family members or friends - Communicate your needs to those around you. Suggest ways that others can help, and accept offers of support.

• Take some time to care for yourself - Rediscover your interests and hobbies – join a local club or group, or take up a new activity.

• Have a health check - make this a priority - Talk to your GP about your concerns and how you’re feeling.

• Get to know other carers and learn from them - Join a carer support group – receive support and learn some useful tips from others in similar situations.

• Make sure you have all the information you need - Contact your local carer service or advice line to see what is available in your community.

In Discover we used relationship circles to identify important relationships in the person’s life. When planning with the person you can use this information to identify who the person wants to maintain contact with, and how you can support this to happen. Where a person is very vulnerable, you may wish to more formally establish a ‘Circle of Support’ to help safeguard the person’s health and well-being. With the persons’ agreement, this may involve convening a meeting of the people who care about the person to be involved in the planning and dreaming about what may be possible. If a person is unable to consent (for example has advanced dementia), the circle may be formed to safeguard the person or support the family. The Circles approach has been used more to support people with disabilities, but could be equally relevant for older people.49

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How do you deal with a situation where you are working with a person who is very isolated but resists your efforts to help them connect with other people? What about if the person has characteristics that may make it difficult for others to accept them (such as poor personal hygiene or a challenging personality)? Is belonging still important for these people?

Role ClaRityIn helping people to overcome isolation and connect with the community, the role of the adviser is often one of facilitator. You are not there to be the person’s friend (although you can be friendly) but to help them connect with old friends or make new ones.

sOmE IdEAs TO hElP ThIs PROCEss:

• be open to listening to, trusting and accepting others in the person’s life

• break the cycle of isolation by looking for ways to bring the person into everyday contact with others – at the shops, local church, library or community centre

• assist the person to re-connect with people from the past

• search for strengths and capacities that might facilitate a meaningful connection

• ask people – don’t wait for someone to volunteer; ordinary people may hold the key to hospitality and friendship

• trust the wisdom of the community – brainstorm

with others to produce ideas you may not have on your own

• strengthen and re-kindle existing relationships – think about how you can nurture those relationships that already exist

• use your imagination – believe in the vision that people can belong!

• find and work with bridge builders; these are people who have a wide range of connections in the community - they can introduce the person to others

• consider the importance of rhythms and routines – it is often good to do things at the same time and in the same place

• recognise the importance of the simple and the ordinary – celebrate things that are quite significant, such as connecting with a neighbour.50

DisCussion Question

“Quality of life is having something to do, having someone to do it with, and having something to look forward to.”

Neil Barringham. 50

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v I N y l T r E A S u r E S“Is it nostalgia that fuels my love of records?

Possibly

There’s memory in a record — the physical sensation of removing the vinyl from its cover and placing on the turntable, the motion of placing the needle on the right point and then the reward of the slight crackle and the fullness of sounds that tumble out of the speakers and surround you… The fact that the covers are artworks in themselves…

It opens something in me. To me, its home.”

Kenneth, 78, has a genuine passion for records. From classical treasures (his favourite is Beethoven) to newer discoveries, his walls are lined with records that somehow seem to swirl and all meet at the all-important record player which takes pride of place in the living room near the large armchair.

Kenneth has been diagnosed with Parkinsons and, as his motor control deteriorates, he is finding it hard to do very simple tasks. Even things like opening a can or chopping up vegetables can cause issues. He has depression and, even though he takes medication, it seems that life has lost some of its lustre since the diagnosis.

If you ask him what loss he felt the most, he answers without hesitation, “the ability to put on a record by myself, to listen alone or to share incredible music with other people.” His hands shake too much now to place the needle on the record.

“I feel — no, I know that if I could just get back to sharing the music I love in the format I love, I would feel so much happier.”

FOOd FOR ThOughT• You are working with

Kenneth to find ways to make his quality of life better. How would you go about finding a solution to the ergonomics of the record player that could work for him?

• How could you support Kenneth to create more connections with people from his community?

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T h E C y C l I N g C l u bTom, a man in his late 70’s, is an inspiration. In his words “leading an active life, full of adventure and passion are critical to having a good life as you age.” Tom has had a life-long love of bike riding which started at the age of 15 when he was living in England. A work colleague challenged him to a lunchtime race. He won that race and was hooked. Since then he has always maintained his love of road racing, spending countless hours on his bike regardless of the weather. Tom’s passion has taken him and his wife Lea on many adventures. At one time they cycled around England and Europe for seven months.

Two years ago Tom’s enduring passion came to a halt. He was a participant in the Tour Down Under Veteran road race and was involved in a serious cycling accident. He was in a coma for 3 weeks and hospitalised for 3 months. He left hospital with long-term injuries to his brain. After 6 months rehabilitation for Tom, his wife was diagnosed with a serious illness requiring treatment one day a week. She contacted an agency for some respite whilst she had the treatment, and the idea of a volunteer taking Tom for a drive was suggested, although this idea was not entirely embraced by Tom.

The coordinator had been captivated by the many photographs portraying Tom’s achievements over many years and heard that Tom had also been a highly respected member of the Southern Districts Racing Club prior to the accident. Her curiosity and knowing the importance of Tom doing something that he loved led her to a Bike Shop where she discovered a tandem bike.

Whilst the cost of the tandem bike seemed prohibitive, this was overcome with the help of the local community and through the Bike Club.

The club members said they are delighted to welcome Tom back. Interestingly enough, following his injury the members of the club were unsure about whether it was the right thing to make contact with him.

These days you can find Tom cycling from Happy Valley to McLaren Vale once a week accompanied by a mate from the Bike Club, both attired in their lycra suits.

“It’s great to be back on the bike, exhausting but good for my soul,” remarks Tom.

Tom’s courage and determination is widely recognised in the cycling community, and a race at last year’s Tour Down Under was named after him.

FOOd FOR ThOughT:• What provided the intial clue about Tom’s

passions? In what other ways could you learn about someone’s passions?

• If you were supporting Tom through the next ten years, what would you put in place to ensure that Tom continued to be involved in the cycling club?

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Think about a time when you were ill or you had injured yourself and required assistance to perform some tasks. Did you think that this would last forever or were you looking forward to the time when you could again do that task for yourself? What was most helpful to you in this situation?

The aim of all services is to promote healthy ageing, which is done through timely interventions that prioritise capacity building and restorative care that will maintain and promote people’s health, well-being and independence.

the appReCiative Question the pRovoCative pRoposition

RationaleIf services are only considered to be in the business of maintenance and support for people, then we miss opportunities to enable people to be more independent, and to be possibly not as reliant on services in the longer term. More active or restorative approaches to home care are gaining credence as a way of improving the lives of older people, and also reducing the ongoing demand on services.

Over the past ten years there has been a worldwide shift from “caring for” older people towards supporting people to remain fit and healthy, remain living in their own home, continuing to be active members of their community and regaining their independence when they experience disabling or potentially disabling conditions.

Independence is something that is highly valued in or society, so too for older people. Becoming dependent and needing assistance can incur feelings of loss of dignity and status.

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Definition

World Health Organization definition of Active Ageing:51

Active ageing is the process of optimising opportunities for health, participation and security in order to enhance quality of life as people age. It applies to both individuals and population groups.

Active ageing allows people to realise their potential for physical, social, and mental well-being throughout their life course and to participate in society, while providing them with adequate protection, security and care when they need.

The word “active” refers to continuing participation in social, economic, cultural, spiritual and civic affairs, not just the ability to be physically active or to participate in the labour force. Older people who retire from work, are ill or live with disabilities can

remain active contributors to their families, peers, communities and nations. Active ageing aims to extend healthy life expectancy and quality of life for all people as they age.

“Health” refers to physical, mental and social wellbeing as expressed in the WHO definition of health. Maintaining autonomy and independence for the older people is a key goal in the policy framework for active ageing.

Ageing takes place within the context of friends, work associates, neighbours and family members. This is why interdependence as well as intergenerational solidarity are important tenets of active ageing.

things to ConsiDeR

Ensuring the health and wellbeing of older people and promoting recovery and re-ablement requires consideration of:

• the assessment of health needs, involving other relevant professionals as required

•the prevention of disease

• promoting activities known to promote good health (such as good nutrition and exercise) and reducing unhealthy habits

• helping people to access treatment when required in a timely manner

• promoting rehabilitation and recovery as soon as possible after an event

• encouraging re-ablement after an illness or incident; that is learning or re-learning the

skills of daily living, or utilising relevant equipment to compensate for the impairment

• helping people to manage chronic disease to reduce the impact on their lives

• collaborating with other health services to ensure clarity on common goals, and consideration of all possibilities and constraints

• considering emotional and spiritual well-being as well as physical health.

There is also a need to balance people’s health needs with the other parts of their life. While encouraging people to do things for themselves is positive, if it takes a long time or means that they are missing out on important activities or interactions, then it may be preferable for the person to have assistance.

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tools

PAThs TO WEllnEss And IndEPEndEnCE

1. prevention of the disablement process

The following diagram shows the link between experiencing an adverse event, the development of an impairment and the creation of a disability:

2. recovery/re-ablement

These are capacity building approaches which emphasise growth and development so that the person can learn or re-learn skills that are important for participating in life at home, at work, in recreational pursuits and in relationships.

3. slowing the progress of increasing frailty and chronic conditions

Determinants of wellbeing

Martin Seligman, in his book Flourish: A Visionary New Understanding of Happiness and Weel-being52 researched the determinants of wellbeing, and found that the core features were positive emotions, engagement and interests, and meaning and purpose. Being able to give and having achievements were also important.

hEAlThy OldER PERsOn

Falls Prevention

Falls are the leading cause of injury-related deaths, hospital admission and emergency department presentations in older people.

An adviser can help a person to reduce the risk of a fall by encouraging them to:

• improve their balance, strength and flexibility

through programs such as strength training and Tai-Chi

• wear shoes that are comfortable, fit well and are wide enough in the toe area, have low or no heels and slip-resistant soles

• improve home safety through adequate lighting, night lights and/ or movement sensors

• keep walkways clear and well lit, and repair or replace carpets where there are worn areas, holes or long threads

• check that mats and rugs are secure and have no tears or wrinkles; put adhesive strips on mats

•install grab rails in the bathroom

•store and use medications safely

• clear outside areas, remove slippery surfaces (such as moss or lichen or wet leaves), mark steps with white paint, repair uneven paths, keep steps and paths well lit

• keep healthy and talk with health professionals about how to reduce risks of falling through dizziness or other conditions

•have medication reviewed for side effects

•have eyes tested annually

•visit the podiatrist regarding any foot problems.

t h e d i s a b l e m e n t p r o c e s s ADVErsE EVEnT

DisABiLiTy

iMpAirMEnT

Health condition, injury, loss

Affects on physical or mental

functioning

difficulties with activities of daily living

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How do you approach a situation where a service recipient is engaging in behaviors that are harmful to their health, but won’t discuss the issue or ignore your attempts to help them to change that behaviour?

For example if a person has a problem with smoking, alcohol abuse, or if they are refusing to get medical treatment or leaving things around that may increase the risk of falls? What would you do?

REABlEmEnT

Research into the re-ablement approach found that “…instead of providing largely passive services to ‘support’ and ‘maintain’ a person at home, an active service model emphasises providing timely interventions that prioritise capacity building … with the aim of maintaining and promoting a client’s capacity to live as independently as possible”.54

The Social Care Institute for Excellence55 in Britain found the following:

• Reablement helps people learn or re-learn the skills necessary for daily living, which have been lost through deterioration in health and/or increased support needs. A focus on regaining physical ability is central, as is active reassessment.

• Reablement is becoming the ‘default’ initial response to presenting needs, rather than a service that is restricted to people on discharge from hospital.

• There is a high probability that reablement is cost-effective; reducing ongoing support needs through sustaining independent living.

• Commissioners and service providers should recognise that results for people with different needs vary although no-one should be excluded from reablement on the basis of their health state.

• People using the service and their families appear to welcome reablement. Where care needs are ongoing, extra care should be taken to ensure the subsequent provider continues the reablement ethos.

• In planning a reablement service, a strong priority should be placed on the involvement of occupational therapy.

• Reablement requires care workers to adopt a ‘hands-off’ approach to supporting people, which is arguably distinct from practice in conventional home care. Managers should provide appropriate training and supervision to support this ethos.

• Although the reduction in ongoing support is a key objective of reablement, commissioners and managers should ensure that the aim of improving people’s wellbeing is at the heart of the service.

Role ClaRityThe adviser will bring positive assumptions about the capacity of an older person to strengthen their physical and emotional capacities. It is not necessary to have expertise on all areas of health, but an adviser needs to be open to working with a range of health professionals to support a healthy ageing approach. The skill of the adviser’s role is to encourage the discussions about wellbeing issues, provide information, and help the person think about how they can improve their wellbeing and take preventative measures.

DisCussion Question

ResouRCes

“Wellness is based on the principle that people want to retain their

autonomy and build their capacity, which in turn has a positive impact on their self-esteem and ability to

manage day to day life” 56

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C O O k I N g h E r w A y b A C k T O h E A l T hDenise found herself losing motivation, just sitting and staring most of the day. Some days she couldn’t even be bothered showering or dressing. She hadn’t done any painting or creative writing for ages and couldn’t be bothered meeting with her friends or listening to her music. She was also finding it difficult to manage her mental health issue, and kept having ‘episodes’. When Denise went to the Doctor he said she now has diabetes and advised her to change her eating habits. Denise had always ‘lived on frozen meals’ and never bothered to learn to cook. The Doctor told Denise she could get some help through a local agency and gave her the number to call. Denise phoned the agency and told them what the Doctor had said. Denise said she wanted to learn about diabetes, what kind of food she needed to eat and how to cook it. Denise said she didn’t want other people telling her what to do and wanted to live her life her way. The agency said that a worker, Jennifer, could spend some time with Denise each week, for up to six months. It would be up to Denise to let Jennifer know what help she wanted. When Denise said she didn’t have a lot of money left by the time she had paid for her medicine, the agency said Denise would only have to pay a small amount. Denise said she was keen to ‘pay her way’ and was confident she would manage this. The agency said they would phone Denise before the end of the six months to see how she was going and to see if she needed more help. They also let Denise know she could call them at any time if she wasn’t happy or needed any changes.Jennifer visited Denise at home and said she had diabetes too. Jennifer said she didn’t know a lot about diabetes either and had been planning to go to some information meetings at the local Health Service. Denise said she would like to go too, so they arranged to meet there for six-weeks and learn together.Jennifer went with Denise to her local shopping centre so Denise could learn to identify what vegetables and fruit looked like and how to check freshness and the amounts needed. Denise told Jennifer what she liked to eat and they found easy to cook recipes in magazines and at the Health Service.Every week they would shop for the food, return to Denise’s home and prepare and cook the food. Jennifer only gave Denise help when she asked, or when she could see a ‘meal disaster’ about to happen. They had a lot of laughs and Denise found out she liked to cook and was inviting her friends over to try out her new skills. Denise phoned the agency after five months to say she didn’t need Jennifer’s help any more. Denise said she had learnt all she needed to know, that she knew how to shop, cook and was enjoying the food. Denise thanked the agency for the help and said she would phone again if she needed to. The Doctor was pleased with the changes that Denise had made.

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Dream13f A C I l I T A T E C h O I C E A N d C O N T r O l S O p E O p l E A r E d E C I S I O N m A k E r S I N T h E I r l I f E

Think of a time when someone gave you information, encouragement, had faith in you, or gave other support to help you make choices. How much better were your decisions and sense of control?

Advisers can work in ways so that the person maintains a sense of autonomy in their own lives and authority over their own lifestyle and decisions about their support.

the appReCiative Question the pRovoCative pRoposition

RationaleAn unfortunate pattern is that as people age, others (including professionals) start making decisions on their behalf. A person might make small decisions in life, such as what to eat, but it is others who might, even with good intentions, make the big decisions about their home, their relationships, their capacity, etc.

Therefore, it is important to remain conscious of the importance of each person maintaining autonomy and authority over his or her own life.

Definition

Autonomy(noun) • the right of self-governance, personal

freedom, freedom of will57

Authority(noun) • to have power, control, jurisdiction,

influence, mastery58

Efficacy(noun) • the ability to produce a desired or

intended result59

“Authoritarian methods do not produce independence: they reinforce

dependence. Independent functioning is not simply the ability to do something, but also the ability to decide what to

do. It is not only the ability to take care of oneself, it is also the ability to take responsibility for oneself. Autonomy

and independence do not grow out of being told what to do and when to do it. It is only by having his or her needs

considered, by becoming a participant in the decision-making process, that a child

develops the capacity for autonomy.” Elaine Heffner

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things to ConsiDeR

tools

Look at your communication style and your agency’s procedures to find ways to allow a service recipient to enact their autonomy and efficacy.

Consider why an agency might be reluctant to enable each person to have a high level of choice and control. It could be based on assumptions that the person or family is not capable. The adviser should avoid, for example:

• making judgements that the risks are so high that the adviser must take more control

•using risk aversion rather than risk management

Consider how a service could reduce the types and levels of choice and control that each person could have. For example:

•The agency provides a menu approach.

• The service’s staff members interpret their responsibility and the responsibility of the agency too broadly. This could include:

o using overly intrusive agency processes like complex forms and the requirements of workplace, health and safety

o using rules to eliminate all risks

o rotating a staff member who has low relationship boundaries rather than using education and performance management

o not being conscious of agency procedures that could be relaxed so that individuals could have more choice and control.

Active participation will be encouraged by:

• using language and patterns of communication that encourage people and their families to participate in all care decisions, e.g. ‘asking’ rather than ‘telling’.

• describing the support process as a shared function to promote a sense of autonomy rather than exerting power or control over the person.

• asking people and their families how much they would like to be involved in the process and continuously soliciting their input.

• after you have met with the person for the discovery or dreaming/planning process, asking for feedback on how it went and how they felt at the end, clarifying what each of you has agreed to do as a result.

• providing information about resources and contact details to make it easy for the person to follow up leads themselves.

• checking in from time to time to see if they are feeling overwhelmed with their role or happy with the balance, and remembering to check in with families as well. 60

1. lEvEls OF EmPOWERmEnT

Michael Kendrick61 designed a simple test to discern whether a person who is assisted by services is actually being enabled to make a significant difference, through their own actions, on the character of the service they are receiving. More precisely, of the many important decisions taken that result in the actual design and operation of the services they ultimately receive, how many of these were made by the person, and how many were made by others on behalf of the person.

Six levels are proposed:

level one: this is a level where the person does not make any substantive decisions about their service.

level two: this is a level where the person does not make any substantive decisions about their service, but where the person is routinely informed about the decisions others are making on their behalf.

level three: this is the level at which the person is routinely asked to give advice, (i.e. is consulted), by the actual decision-makers, about his/her personal service decisions.

level four: this is the level at which the person begins to routinely personally make a significant minority of the substantive decisions that constitute their personal service. A significant minority, in statistical terms, might range from 25%-45% of key decisions.

level five: this is the level at which the person routinely begins to personally make a significant majority of the substantive decisions that constitute their personal service. a significant majority, in statistical terms, might range from 55%-90% of key decisions.

level six: this is the level at which the person is so routinely making the vast majority of key decisions that they simply do not any longer believe that they have a meaningful empowerment issue.

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tools – ConTInueD

2. PRACTIsE hAvIng COnvERsATIOns WhERE…

• You connect with the meaning behind the words of the person. For example, if they say something like ‘I am lonely’, seek to understand what this means for them.

•You do not offer solutions at all but rather guide the person to their own decision making.

Become mindful of the challenges in this way of working. Note that this exercise does not mean that you should never offer advice or information; it is about the timing of when these are offered.

sTRATEgIC QuEsTIOnIng

Fran Peavey62 developed a form of communication called Strategic Questioning for use when it is important for an individual or group to identify their own issues, to explore their options and commit to their own solutions. It is built on understanding the distinction between communication that is based on ‘what currently is’ (as if the present is immovable) and communication that is based on ‘what could be’.

ThE FirsT LEVEL: DEsCriBing ThE issUE Or prOBLEM63

1. Focus questions gather information that is already known:

When you look at the river, what do you see that concerns you?

2. Observation questions:

What do you see? What do you read about this situation? What information do you need to gather about this situation?

3. Analysis questions (thinking questions):

What is the relationship of ... to ...? What are the main economic, political, cultural, and social structures that affect this situation?

4. Feeling questions:

How has this situation affected your body? Your feelings? How has it affected feelings about your family, community and the world?

ThE sECOnD LEVEL: sTrATEgiC qUEsTiOns....Digging DEEpEr

Now we start asking questions that increase the motion. The mind takes off, creating new information, synthesising, moving from what is known to the realm of what could be.

5. visioning questions are concerned with identifying one’s ideals, values, and dreams:

How would you like it to be? What is the meaning of this situation in your life?

6. Change questions address how to get to a more ideal situation:

How might changes you would like to see come about? Name as many ways as possible. What are changes you have seen or read about? Here you are trying to find the person’s change view, which will greatly impact their strategies for change.

7. Consider all the alternatives:

What are all the possible ways you could accomplish these changes? How could you reach that goal? What are other ways? What would it take for you to do ...?

8. Consider the consequences:

How would your first alternative affect the others in the context? What would be the effect on the environment? What political effect would you anticipate from each alternative?

9. Consider the obstacles:

What would need to change in order for alternative “a” to be done? What keeps you from doing ...? Decisions become clear around this point. Are you getting a sense of what you want to do? What is in the way of clarity?

10. Personal inventory and support questions:

What support to you need to do ...? What support would you need to work for this change?

11. Personal action questions:

Who do you need to talk to about your vision? How can you get others together to work on this?

ResouRCes

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“We find that people’s beliefs about their efficacy affect the sorts of choices they make in very significant ways. In particular, it affects their levels of motivation and

perseverance in the face of obstacles. Most success requires persistent effort, so low self-efficacy becomes a self-limiting process. In order to succeed, people need a sense of self-

efficacy, strung together with resilience to meet the inevitable obstacles and inequities of life.”

Albert Bandura

How might you respond if the older person is highly reluctant to make decisions and says to you repeatedly ‘what do you think I should do?’

How do you involve a person in decision-making about their own support when they cannot communicate verbally or have a cognitive impairment such as Dementia?

Who else in the person’s network might the service partner with if the person has personal barriers to participating in decisions about themselves?

Role ClaRityThe adviser could be in one or more of the following roles: facilitator, paid ally, and purveyor of advice, information and practical assistance. However, they are not the one who controls the outcomes.

DisCussion Questions

“Don’t wait until everything is just right. It will never be perfect. There will always be challenges, obstacles and less than perfect conditions. So what. Get started now. With each step you take, you will grow stronger and stronger,

more and more skilled, more and more self-confident and more and more

successful.” Mark Victor Hansen

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Imagine if your only relationships were paid ones and your only interests were pursued with people who shared one of your deficits. What would that look like and how would you feel?

Paid-only solutions can lead to a service-dominated life and the person’s usual and past relationships and pastimes begin to shrink. For a person to have a positive future, it is helpful to assume that family and community contribute to older people having good lives.

the appReCiative Question the pRovoCative pRoposition

RationaleThe seat of the stool is a symbol of a person’s ‘good life’. This encompasses their valued roles, sense of home, health, purpose, contributions, what gives them meaning, etc. The four legs of the stool represent four parties - each vital to the person having a better life.

One of the ‘legs’ represents the person, their experience, skills and talents, knowledge of their own past and their hopes for the future. Without their involvement, what might be imagined and created might not be authentic for them or meet their needs.

A second ‘leg’ symbolises those who are family, friends, or even family-like people, such as good neighbours. Members of this group also bring knowledge of the person and potentially a fidelity to the person’s sense of meaning and happiness. These are freely-given and (at least in the past) mutual relationships. Some bring love for the person, which means that they will be less conflicted than say, a service, in their advocacy for the person’s wellbeing.

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Rationale – ConTInueD

A third ‘leg’ is that of community. Community in this instance refers to:

• informal relationships that are geographically, interest, culturally or family based. Therefore community can be the neighbourhood, clubs, churches, sports groups and cultural groups who come together based on a shared factor

• generic resources such as the library, local buses, the GP, the shops and cafes, galleries and garden nurseries.

The fourth leg refers to paid specialist services, such as aged care services, disability services or therapy services.

Each of the ‘legs’ has a purpose and legitimate offerings to the person. For example, it is normal for close family to be involved in personal matters and, in particular, decisions about future lifestyles. Friends typically involve themselves in social matters and might be competent (or learn to be)

in meeting some personal needs. It is through social and economic participation that people feel connection and belonging to community life.

An issue arises when the purposes are blurred. For example, if the service worker acts as a friend or a service offers a gardening group rather than enabling the older person to attend the community one.

Continuing the metaphor of a stool, if one leg is absent or not working well, then it is possible (but maybe unstable) for the person to still pursue a good life. If, however, two or more legs don’t work well, then the security of a good life is threatened.

What also makes the legs more stable is the ‘band’ that connects each of the legs. This could symbolise good communication between parties. It could also symbolise the value of building the capacity of each of the legs, that is, strengthen their ability to imagine a better life and enabling the person to pursue it.

Definition

Community(noun) • the condition of sharing or having certain attitudes and interests in common; a similarity

or identity.64

“The world is so empty if one thinks only of mountains, rivers and cities; but to know someone who thinks and feels with us, and who, though distant, is close to us in

spirit, this makes the earth for us an inhabited garden.” Johann Wolfgang von Goethe

Be mindful that eventually you will be trying to enable:

•the person to be as independent as possible

• the person to stay connected to ordinary relationships, places and pastimes

• family or informal networks to step forward and take an active role in the person’s life

• community to welcome and include the older person

Therefore, without leaping to a solution, be alert to who these people and resources might be.

Use the principle of ‘informal responses before

formal responses’ so that a dependence on services is not created.

Having spelled out the role of services, it is important to note that sometimes work outside of the usual scope might be necessary. For example, if the person cannot ask someone to step forward immediately, the adviser might do this task. Or an adviser might source where the person’s past interest could be pursued in a generic setting.

Some family and/or friends might prefer to provide practical assistance e.g. make a meal or mow the lawn. Others might prefer to keep company with the person or do things together that they used to do.

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tools

When working with a person, reflect on the extent that each of the legs (individual, family/friends, service and community) support the seat of the stool (a good life). What can the person imagine could be strengthened?

Role ClaRityIn order for friends, family and community to step forward, it might be necessary for the adviser and workers to be “small ‘p’ professionals”. Elizabeth Neuville describes this well in the piece below, ‘Small just might be beautiful’.

“We have all known the long loneliness and we have learned that the only

solution is love and that love comes with community.” Dorothy Day

“One of the marvelous things about community is that it enables us to welcome and help people in a way we couldn’t as individuals. When we pool our strength and share the work and responsibility, we can

welcome many people, even those in deep distress, and perhaps help them find self-confidence and inner healing.”

Jean Vanier

Small Just Might Be Beautiful

A reflection by Elizabeth Neuville65

“I am reflecting this afternoon on the idea that “small is beautiful.” … [The phrase] came back to me today, this time in relationship to how I might “be” in the life of a person who has lived a hard and even dangerous life at the bottom of the social ladder. It is beautiful to witness a relationship between two people where a strong and robust person allies himself or herself with a vulnerable person in a quiet way which allows that person to be fully promoted. As a person who has often taken the role of “champion for,” “defender” or “outspoken advocate for” another, I am cognizant of the benefits the person in the “helper” role might get from that – and also of the benefits to me personally, at times.

Today, I am thinking of the relationship where one powerful person (often powerful by accident of birth, good fortune, big expectancies, and unconscious privilege) decides to be “at the feet of” another person, silently promoting, lending a quiet presence, being with someone in a way that lets that person be their best and “biggest.” As my colleague Pam Seetoo has said often, “We sometimes have to make ourselves small so others can be big.” I have to give up a few things in order to be ‘small’ – a bit of my ego, attention, center stage, the role of champion or even ’hero’ in the life of another, but I can afford to give these up, now and then. I have a few people in my life who have modeled this for me and, when you see it, it is exquisitely beautiful and unmistakable. The direct result can be the unfolding and revealing of another human being, who may never have been fully seen or acknowledged. This thought will carry me through the next week, I think.”

Explore the ways that the actions of a service might be a barrier to family, friends or community stepping forward.

ResouRCes

DisCussion Question

14 – ExplOrE Th

E pOSSIb

lE CON

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S Of fA

mIly, CO

mm

uN

ITy AN

d SErvICE

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Dream15u S E C r E A T I v E T h I N k I N g

Think about a time when you felt “stuck” when dealing with an issue and someone was able to look at the situation in a totally different way. How did that help you find a constructive way out of your situation?

To encourage creative responses:

• the service enables creativity at an individual level in response to needs and does not have unnecessary restrictions that inhibit individuality

• each set of circumstances will be given due regard at all times

• the service encourages innovation and creativity with due attention to risks

• processes are in place to ensure service recipients feel free at all times to question service practices when they perceive them to be unduly rigid or restrictive

• advisers look for the possibilities rather than the barriers

• staff members are able to challenge unnecessary restrictions within the service.

The adviser demonstrates the ability to make exceptions, minimise bureaucratic processes, and shows flexibility and creativity in meeting individual needs. Service recipients are encouraged to question service practices when they are unnecessarily restrictive or rigid.

the appReCiative Question

things to ConsiDeR

the pRovoCative pRoposition

RationaleServices can have a tendency to propose standardised solutions to issues facing service users which can prevent individualised solutions being crafted. Factors not relating to the needs of the person (such as staff, funder or organisational needs) can gain priority over the service user’s needs. This area of quality requires services to be flexible and creative in meeting the needs of service users and overcoming the barriers that may prevent this from occurring.

Definition

Creativity(noun) • The ability to transcend traditional ideas, rules, patterns, relationships, or the like,

and to create meaningful new ideas, forms, methods, interpretations, etc.; originality, progressiveness, or imagination.66

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ThE sIx ThInKIng hATs (OR mOdEs) - dE BOnO67

De Bono’s Thinking Hats is a simple technique that helps people become more effective by finding different ways to approach a problem. Thinking is split into six distinct categories, each identified by its own coloured, metaphorical “thinking hat.”

By mentally wearing and switching “hats,” you can easily focus or redirect your thoughts or conversation.

tools

Green Hat Thinking focuses on creativity and innovation: possibilities, alternatives, solutions and new ideas. It provides a specific time that is dedicated to creative thinking and innovation. While an adviser will need all six hats in the process of working with a person, there is a need to highlight putting on the “green hat” and forgetting about the others for a moment (like the black hat telling you something is not possible or not allowed). Green Hat Thinking helps us find new ways of doing things, and it also provides an opportunity to think about ways to overcome concerns identified during Black Hat Thinking.

ThE TEn mInuTE mEETIng

The ten minute meeting is a technique to engage your colleagues in helping you with an issue without taking up a lot of their time. This kind of conversation may happen in your organisation already over a cup of tea, but you can also utilise it to help generate creative responses. Ask a few colleagues if they can meet with you for 10 minutes. Spend a minute outlining the situation you are facing, and then ask each one in turn to make a suggestion or ask a question. The purpose is not to evaluate each suggestion, but to get a list of ideas to follow up (it may help to have a whiteboard). When you have your list, thank your colleagues and take the list away to think about.

TyPEs OF CREATIvITy:68

Fluency - The ability to generate a number of ideas so that there is an increase of possible solutions or related products.

Flexibility - The ability to produce different categories or perceptions whereby there are a variety of different ideas about the same problem or thing.

Elaboration - The ability to add to, embellish or build off of an idea or product.

Originality - The ability to create fresh, unique, unusual, totally new, or extremely different ideas or products.

Complexity - The ability to conceptualise difficult, intricate, many-layered or multifaceted ideas or products.

Risk-Taking - The willingness to be courageous, adventuresome, daring- trying new things or taking risks in an order to stand apart.

Imagination - The ability to dream up, invent, or to see, to think, to conceptualise new ideas or products- to be ingenious.

Curiosity - The trait of exhibiting probing behaviours - posing questions, searching, being able to look deeper into ideas and wanting to know more about something.

CREATIvE ThInKIng CARds

One tool that can help your creativity is the Creative Whack Pack of cards. Each card gives you a different strategy to look at an issue or situation in a new way. Try it when you are stuck!69

There are many similar tools available free on the web such as the Innovation Solutions website. 70

ThE WhITE hATThe White Hat calls for information known or needed.

ThE REd hATThe Red Hat signifies feelings, hunches, and intuition.

ThE BlACK hATThe Black hat is judgement—the devil’s advocate or why something may not work.

ThE yEllOW hATThe Yellow hat symbolises brightness and optimism.

ThE gREEn hATThe Green hat focuses on creativity: the possibilities, alternatives, and new ideas.

ThE BluE hATThe Blue Hat is used to manage the thinking process.

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How do you approach a situation where you and the person you are working with have come up with a creative solution to the situation you are facing, but the solution falls outside of your service’s guidelines?

Role ClaRityWhile an adviser has a duty of care to ensure a sensible response to a person’s needs, they also have a responsibility to think laterally to find ways around issues. They may also need to advocate for the person when unnecessary bureaucratic restraints or rules are inhibiting their ability to meet the person’s needs.

DisCussion Question

Creativity is the ability to make something original, to imagine things that don’t exist, and to come up with new ideas. Creativity is the ability to look at everyday items and events in

new ways. Creativity can make common things special and special things more

common! Dr. Allah Bakhsh Malik

m r S g O r d O N ’ S h O u S E h O l dI visited Mrs Gordon at home following her discharge from hospital and was greeted by her grandson who shares the home with her. She was lying in bed with her quilt covered in a confusion of papers — unpaid bills, mail and documents. It was obvious that Mrs Gordon was still in a lot of pain and the medication had made her slow thinking and vague. She struggled to understand why I was there and what I was able to do to support her.

In order not to add to her confusion I tried to explain as succinctly as possible that my involvement in her life was to assist her to regain her health status and support her in her rehabilitation after a longish stint in hospital. Together we were able to establish that her most pressing needs were to have assistance with showering as she was struggling to walk, some equipment to help her in her day to day home life, along with some help cleaning. She was most adamant about the cleaning as she was feeling very out of control in her usually spotless house.

With all of the paperwork at hand, the house was in disarray; the cupboards were cluttered with foodstuffs, the floors were unswept and the carpets were littered with lint and grime.

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Her grandson Jake had done his best but to quote Mrs Gordon, ‘Men don’t seem to see a mess’. Her grandson had looked after his own space and done the washing and that was about it. However, in talking with Jake it was obvious that he was very concerned about his grandmother with whom he had lived since he was a baby. He had organised a bell system so that his grandmother could ring for him if she needed anything.

So the home help services commenced and, over time, with adjustments to her medication coupled with Mrs Gordon’s determination, an attribute that I grew to see was part and parcel of this stoic country lady, her health status improved.

Over time the home returned to its original state of tidiness and order, reflecting the way that Mrs Gordon operated. Very quickly I discovered that she had been an astute business woman employing a wide range of people on her rural property. She told me that she had been supportive of young employees who needed a bit more nurturing and tried to be fair and give people a go.

It was for this reason that she was anxious about her grandson Jake who was on the cusp of leaving his teen years behind, but who was to this date unemployed. Jake spent most of his days lounging around at home with a steady stream of ‘mates’ joining him in idleness. He didn’t have his driver’s license and before her illness Mrs Gordon had been accompanying him on his endless drives to strengthen his driving experience.

It was obvious that if Jake’s situation improved Mrs Gordon would also be at a better place emotionally. The first thing we discussed was the driving. To assist Mrs Gordon a volunteer was organised who spent some time joining Jake on his drives and freed up some time for Mrs Gordon. It took some time but with the volunteer and the services of a driving instructor Jake gained his license. This was a huge step and meant that he could now begin looking for a job.

Mrs Gordon’s upbringing and own work ethic meant she could not rest with her grandson only getting occasional seasonal work and being financially abused by unscrupulous employers. It was determined that Jake needed gainful employment. I spoke to people I knew in a range of industries but to no avail – it seemed the timing and economic down turn meant jobs were not easy to find. However it was a casual conversation with a colleague about the problem of Jake that changed the tide. She

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Desig

nknew someone who was employing people for his business and was not having success with prospective candidates.

I visited Mrs Gordon and Jake and talked about the prospect of full time employment. I communicated that it was imperative that Jake convey to the prospective employer that he was keen and committed. The rest is history - Jake grabbed the opportunity at hand and has now been employed for six months. His self worth and esteem have lifted as he has been given more and more responsibility within the job. He had shown aptitude and initiative and his grandmother has expressed the thrill of seeing him organise himself each night for the day ahead, that is, getting tools ready and lunch packed, going to bed early as he needed to rise early, sharing driving with other employees while still doing the washing for her much more frequently. Jake loves his job and enthusiastically shares with his grandmother about his daily tasks and this connection has made them closer than ever.

Mrs Gordon now goes out each week to a Club which she loves. She told me she looks forward to meeting her friends at the Club and has been propagating plants to give away there. Her health is now an exciting mix of contentment and challenge. As the situation with Jake changed, so has Mrs Gordon. Life, for her, has never been better.

FOOd FOR ThOughT:• What were the physical and practical needs the adviser identified? What were the emotional

and personal needs the worker identified?

• You are asked to visit Mrs. Gordon year on. Jake is getting ready to leave home and move out with his girlfriend. What steps would you take to help this transition?

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nIdentify what should be the ideal.Co-design the future arrangements.

The Design stage bridges what is ideal and what is possible. It is often thought of as the ‘goal-setting’ and ‘implementation’ stage. The information we have gained from speaking with people about their individual preferences and needs is then translated into agreed goals and activities. These activities will allow all parties (the service user, informal networks and the adviser) to contribute towards the achievement of the identified goals.

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Design16A g r E E O N T h E g O A l S T h A T w I l l w O r k T O w A r d S T h E v I S I O N O f A p O S I T I v E f u T u r E

Think about a time when you really set your heart on achieving something. Were you really clear about what you wanted? Did that help you to achieve it? Were other people involved in helping you to achieve your goal?

After getting to know a person and understanding their strengths and aspirations, advisers will develop and agree to realistic goals with the person. These goals will define what the partnership with the service will aim to achieve with the person, and how each of the parties will contribute.

the appReCiative Question the pRovoCative pRoposition

RationaleWithout goals, we can become stuck in the way things currently are. If services are only considered to be in the business of maintenance and support for people, then we miss opportunities. The process of setting goals is integral to your work as an adviser. Goals are a way to gain agreement between you and the person being supported about your purpose for being there and how you can help them achieve their goals.

Definition

Goal(noun) • the result or achievement toward

which effort is directed71

Knowing your destination is half the journey.

Anon

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Some people may not relate to the use of the term ‘goals’ when accessing a service. Advisers may need to develop different ways to talk about this idea while keeping the core principles. The key is that any assistance provided to a person should be purposeful and support them to be as independent as possible.

ThE gOAl sETTIng PROCEss

1. First, negotiate with the person until you both agree on the overall aim of the support of your service. This is an overall, medium to long term outcome, perhaps relating to one of the life areas listed below. For example, “I really want to remain at home” or “I want to be independent of supports as soon as possible”.

2. Describe the current situation in relation to that aim. Write down a description and quantify if possible. This will act as a “baseline measurement” and will help you later to identify what has been achieved and celebrate successes.

3. Agree what the specific goals are over the following few months that will help to achieve the overall aim for a positive future in the longer term.

4. Goals should be SMART:

•specific

•measurable

•Achievable.

•Realistic

•Time specific

Note: The goals should be expressed in the person’s words and avoid jargon.

5. Define the actions and steps that the adviser and the person and/ or family agree to take to work towards this goal.

6. All parties involved should agree to and sign the goals document.

7. In your reviews with all involved, go back to the goals you’ve agreed to and clearly document your progress.

lIFE AREAs

The following list covers life areas where goals can be set.72 Setting a goal is highly individualised, so not everyone will have goals in all of these areas, but the list acts as a prompt to consider many areas:

•Bodily integrity, health and well-being.

• Personal security and relationships, including support for carers.

• Supporting the continuation of roles or assisting to gain new roles in work, education, recreation, community life, family life.

• Supporting people to gain autonomy and control over their life, and enable choices.

• Enrichment of life experiences and community involvement.

• Maintaining, developing and enhancing skills and abilities.

•Economic security and independence.

• Discovery and expression of self and individual uniqueness and spirituality.

The following chart is a possible layout you can use to set, track and measure goals:

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Have you ever been in a situation where you identified an achievable, long-term goal that you felt was desirable for a person, but were unable to discuss it with the person? How could you approach that in a goal-setting session? Do you think it is always necessary to agree on all goals up front?

DisCussion Question

tools – ConTInueD

AIm CuRREnT sITuATIOn gOAl ACTIOns REsPOns-

IBIlITy TImE FRAmE

life area Eg Bodily Integrity, Health and Well-being

Example:Improve Physical well-being

Cannot move around the house without physical support from carers

To improve independence with mobility as evidenced by the ability to move around the home with a walking aid within 3 months

* Arrange Occupational Therapy Assessment

* Select needed aids/equipment & apply for funding to purchase

* Do a home safety audit

* Rectify any falls risks

Co-ordinator

Co-ordinator & older person

Home Owner (Co-ordinator provide checklist)

Home Owner/family

Within 2 weeks

Within 2 weeks of receiving assessment report

Within 3 weeks

Within 6 weeks

life area Eg Enrichment of life experiences and community involvement

Example:Reconnect with old friends

Not going out due to lack of transport and embarrass-ment about impact of storke on speech & mobility

To attend bowling club once a week for lunch with former bowling friends

* Arrange Transport

*Find appropriate carer or companion to get ready and accompany

*Contact friends

* Assess if communication assistance/aids needed

Co-ordinator

Co-ordinator & older person

Older person with assistance

Referral to speech therapist

Within 3 weeks

Within 2 weeks

Within 3 weeks

Refer within a week

Role ClaRityThe person may expect that your role is just to arrange practical assistance, or to do everything for them. You need to be clear that goal-setting is a shared process that is focussed on their needs and life goals. That may also mean broadening their horizons to think about their social and spiritual domains, for example, and not just physical issues. At this stage you should also be helping them to identify the roles that are important to them, and how you can support the maintenance of those roles. Cultural factors also need to be taken into account.

You are never too old to set another goal or to dream a new dream.

C S Lewis

A goal without a plan is just a wish.Larry Elder

gOAl sETTIng FRAmEWORK

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q u A l I T yIn talking with a man who had been a master chef for most of his life, I was reminded once again just how important a quality product is. He told me that he had a wonderful apprenticeship, four years in all, on luxury ships. He felt he had the best life possible, working in a job he loved and living in the marine environment. He loved the sea and he thoroughly enjoyed providing beautiful meals for the passengers who also chose to spend their holidays cruising around. He told me that a quality product in the food industry depended on three ingredients:• The meals must be visually appealing/appertising• The Meals should be prepared using the very best ingredients• The food should taste wonderful

He said the type of passenger that patronised a cruise ship expected the very best of service in all departments, especially the cuisine.The quality of food would actually determine to a large part how people enjoyed the cruise.He said he learnt very quickly that near enough is not good enough. Whether he was preparing breakfast or creating a gourmet’s delight for the Captain’s dinner, the same kind of care and precision went into the preparation and presentation.He said that the same standards have spilled over into his own life. When his wife was very ill and her appetite very poor, he would create for her tasty morsels that incorporated his ‘cruise ship standards’. His efforts were rewarded with the sight, smell and taste of the food, enticing her to nourish

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her frail body. Are we always testing what we do against our value base? Do we present ourselves in a way that is appealing: neat/tidy appearance, respecting of people’s ideas and property.Do we offer a quality service, always prepared to ‘bend over backwards’ to provide the very best we can? Are we prepared to go ‘that extra mile’ for people by going out on a limb for them so that they are listened to and valued?Do people taste and see that what we provide is good? Is the proof of the service pudding in the eating/sampling? When we discover a fine restaurant with delicious food the idea is to patronize it on special occasions so that the food always remains a treat. If, however, we decided to eat there with frequent regularity the whole taste/enjoyment experience would not be thesame. The same variety should happen with the ‘service restaurant’.

The idea is to be available to assist and encourage natural networks so that we become a facilitator to flavouring the lives of people with the ‘normal’ community supports. When the clients are feasting on us continually, devouring platefuls of ours and other services, in fact greedily wanting more, they go from quality to quantity, from ‘The Manse’ to ‘Charlie’s Diner’. Our help becomes a hindrance in living a normalized existence. They go from satisfaction to indigestion as they over eat on a diet that holds no substance and no lasting social, physical or mental rewards.We should be endeavouring to provide a cuisine that that keeps people fit and continually building on life strengths rather than a service diet that leads to gluttony and apathy.

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Design17S C O p E O f r E S p O N S I b I l I T I E S

Think about a time when you were grateful that someone was very honest with you about what they could and could not do to assist you? How did this help you at the time?

Services will be clear about their role and what they can and cannot do for and with the person. Advisers will also be clear about the approach that they are planning to take, such as encouraging independence, self-direction and restoration of health where possible. The adviser’s role will be purposeful and goal-directed. Services also have a facilitation role and should not overlook pressing needs. If they are unable to meet these needs they should discuss with the person referrals to other services.

the appReCiative Question the pRovoCative pRoposition

RationaleIt is important that the service does not create unrealistic expectations, but also that people are aware of the support available. The service should also be clear about the period of time when the service might be available, and under what circumstances the service could cease.

Advisers should encourage the person to take an active role in arranging their supports, and utilise a restorative approach to maximise their health and well-being. It is also important that a service provider not over-state their responsibilities. This occurs when, for example, a service assumes that they are responsible for all matters to do with someone’s home and lifestyle. If this is done, then organisational responsibilities intrude into the individual’s personal sphere, such as when a service recommends someone not go on holidays or move into a residential service.

Definition

Purview(noun) • The ‘purview’ of a service is the scope or limit of influence, authority, competence,

responsibility or concern in the lives of service recipients that would generally be perceived as the appropriate and/or properly delegated one for a particular service.73

Restorative(noun) • Tending to impart new life and vigor to; invigorating - imparting strength and vitality;

promoting recuperation; healthful - conducive to good health of body or mind.74

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BEIng ClEAR ABOuT ThE lImITs OF ThE sERvICE

In order to avoid confusion and possible disappointment, the adviser should be very clear up front about what the service can and cannot do with the person. This should not pre-empt the discovery and dreaming stages, nor limit possible creativity, but rather create the boundaries that you can work together within.

Factors that may need explanation are:

• the nature of your role and the limits of your authority and responsibility

• who is funding the services and the eligibility criteria

•how family and friends can be involved

•any time limits for the service

•the criteria for discontinuing the service

• roles and responsibilities of the person receiving services

•complaint mechanisms

•the availability of independent advocates

• the range of services available from your organisation and other services in the community.

duTy OF CARE

The law imposes a duty of care on everyone (workers, the general public, etc.). This is a duty to take reasonable care and avoid injury to other people or damage to property as a result of our action or inaction. There is a duty not to be careless, by taking reasonable steps to avoid harm, while supporting sensible risk-taking relevant for each individual.

In cases of professional negligence involving someone with special skill, that person is expected to show the skill of an average member of that profession. In working with people there is a need, through planning, to minimise possible harm. It is not possible to eliminate risk, only to formulate strategies to minimise it. Enabling someone to undertake or engage in a risky activity does not make you negligent. Failing to take any steps to minimise foreseeable harm could be. This is called the ‘dignity of risk’.75

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tools

“Our duty is to encourage everyone in their struggle to live up to their own

highest idea, and strive at the same time to make the ideal as near

as possible to the Truth.” Swami Vivekananda

REsOlvIng EThICAl dIlEmmAs

Some questions to help you resolve ethical dilemmas that may have a duty of care component:

•What are the foreseeable risks in this situation?

• What are the spiritual and cultural values of the participant?

• Do I understand and respect the views of both the participant and their significant others?

• What impact does this issue have on the participant, who has rights, dignity, and a hope for a better life?

•What are my values?

• Are my values in conflict with those of the participant?

•Am I imposing my own values on the participant?

• What circumstances affect the participant and/or the participant’s family?

• What is the social and health status of the participant, and what other related factors may influence the situation?

• Do any of the stakeholders involved in the particular situation have a particular investment in the outcome because they have a special need, or because we have particular obligations to them?

• What are the professional values and standards applying to my role?

• What are the values and code of conduct of my organisation that are relevant to this situation?

•Which laws, if any, are relevant to this issue?

• What is my legal duty of care? What is my ethical duty?

ThE OPTImAl sOluTIOn

In navigating any ethical dilemma, the adviser should seek to combine all of the above considerations in order to help them determine the optimal solution for that particular situation. This optimal solution is arrived at by simply selecting the option with the highest overall ethics quotient and that produces the best possible outcome for those involved.76

What could you do if you were faced with a person who had needs that were clearly beyond the scope of the program you were working with?

Enabling risk, ensuring safety: Self-directed support and personal budgets, SCIE Report, 2010.77

DisCussion Question

ResouRCes

Role ClaRityIn general terms, the more vulnerable a person is and the fewer informal supports they have, the greater the role a service is likely to play in their lives (i.e. the wider the ‘purview’).

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Design18T h I N k T y p I C A l A N d p E r S O N A l

Think about a time when you received a very personalised service that made you feel special and unique, perhaps from a hotel or restaurant, or a health service. What did people do that made it special?

Having come to understand the person, their strengths and needs, and the goals and lifestyle that are important to them, the adviser will arrange the supports that they have agreed to in a timely and efficient manner. These supports may include paid services as well as facilitating links to community resources and supporting informal networks. The supports will be provided in a way that is typical for any valued citizen in the community (see definition of Culturally Valued Analogue below).

the appReCiative Question the pRovoCative pRoposition

RationaleMeeting the needs in the same ways that others do reinforces the shared humanity of all. For example, the need to pursue an interest when that interest is ‘books’ can be met by joining the local book club, not joining a day service.

Receiving a personalised service is one which is designed for and with a particular individual. It is different from having personable staff who offer a menu of service options. It is ‘ordinary life’ based, not service based. It is ‘possibility oriented’, not service oriented.

One of the most beautiful and helpful concepts for me over the years has been the idea of the “culturally valued analogue”, a term invented

by Wolf Wolfensberger and taught in Social Role Valorization. The “CVA” as we call it, is taking a look at “what happens for typical

citizens who have a valued status” in a particular area of life. Quite simply, our colleague Tom Doody has described it as “studying the ordinary”. This has great and elegant utility when someone has a

vulnerability and may need some safeguarding from a wholesale leap into the “alternate path” of clienthood with all its peril.

Betsy Neuville79

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Practise ‘thinking typical’ by answering the following questions in typical ways:

WhAT ARE TEn WAys TO dO EACh OF ThE FOllOWIng?

•Get a meal if you can’t cook?

•Pursue an interest in books?

•Pursue an interest in woodworking?

• Have groceries in the cupboard if you can’t drive or use public transport?

•Be clean and presentable?

•Get somewhere if you can’t drive?

Once you have your list of ten ways, separate out those that are disability and aged care services from typical and generic ways.

An adviser can easily assume that paid services are the answer to all a person’s needs. When ‘thinking typical’, there is an assumption that ordinary citizens and generic services could meet the needs of an individual. If this assumption is followed, then the role of the adviser is to support that to happen, possibly by using building community capacity if necessary.

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Culturally Valued Analogue78

There is nearly always more than one way to meet a need. By ‘thinking typical’ as a first problem solving approach, an adviser can identify a range of solutions that reflect how anyone else would meet that need. Solutions are then informal rather than a formal arrangement with a service, unpaid rather than paid, and are generic rather than using a paid specialist like an aged care or disability service.

In summary, get into the habit of ‘thinking typical’ before thinking of a service response.

What other ‘think typical’ questions can you identify for your team to explore?

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DisCussion Question

tools

A Culturally Valued Analogue (CVA) is the concept of looking at how a similar need is met in the valued society, and using this as a model for service development.

A Culturally Valued Analogue is something that:

•is encountered with reasonable frequency in the valued sector of society

•most sectors of society would be familiar with

•most members of society would hold positive expectations and images of

•constitutes a valued parallel to a practice performed by or with vulnerable or devalued people.

Human services usually address the same human needs that all people have including physical care, a place to live, opportunities for growth and development, health care and education.

However, the manner in which many services address these needs can be different from the way other citizen’s needs are addressed. The result of this is that people who receive services can be seen as “different” which can reinforce negative stereotypes.

The more those services match the valued equivalent, the more positive the image of the people who utilise that service will be. It is helpful to think about what ‘home life’ or ‘community life’ typically look like for people. What kind of roles and relationships do most people have?

(Note: The Appreciative Questions at the beginning of each topic in this handbook help you to think about the Culturally Valued Analogue of each process we are describing).

“People seek community not services.”Simon Duffy80

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T h E S T O r y : E r I C h A N d u r S u l AErich and Ursula are in their 80s and have been married for 63 years. They both had traumatic experiences during the Second World War. Ursula lost family and Erich witnessed brutality and almost starved to death in the march across Russia with the German army. They emigrated in 1954 with two young sons and built a house in the suburbs a few years after arriving in Australia. They both attended English classes and Erich was quickly promoted to a leading hand position as a toolmaker at GMH where he remained until he retired.

When their daughter went to high school, Ursula started working as a carer of young people with intellectual disability where she stayed until she retired. They made life-long friends among the German community in Australia. However, only a few are still alive and even these are not in regular contact due to the effects of distance, health issues and limited mobility.

Erich has been an active member of the German Association for many years and regularly drinks at the bar with his friends and associates. Ursula was less interested in the club and spent her leisure time in art classes and china painting until her eyesight failed. Although she had eye surgery and her sight was restored she never resumed her china painting. During this period she suffered pain in her spine, became depressed and dependent on drugs for pain management.

After moving into their current home, Ursula became physically frail and struggled to manage her depression. She now suffers memory loss and lacks the confidence to leave her home and is reluctant to visit family for social events and celebrations. When home alone she becomes very

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agitated and forgets where Erich has gone even though she is encouraged to write down where he is and when he will return. Ursula receives home care support and respite.

Erich’s sight deteriorated and by the age of 80. He had only peripheral vision and was not able to drive. He bought a gopher which he still uses for local shopping, and he is able to take the bus to the shopping centre and into the city. He enjoyed reading in his leisure time but can no longer read print even with a magnifying device. He can see his large screen TV and manages electronic devices mainly by memorising the numbers and position of the buttons. Erich still goes to the German Club to drink with his mates and watch the races on Saturdays when his daughter, Anna, is available to spend the afternoon with Ursula.

When Anna couldn’t spend a Saturday with her parents, she had arranged for a respite carer to be available instead. Erich refused the service saying that he didn’t like carers in the house on the weekends.

His son Hans visited from Sydney one weekend and took Erich to the German Club. It emerged from the conversation that the real reason for not accepting the service was that he was not comfortable with the idea that a paid service was put in place so that he could go out drinking.

Together they again discussed possibilities for support with the aged care coordinator and they worked out a new proposition. A carer would come on Saturdays to take Ursula on a social outing or for a walk to improve her fitness and mobility. When the goal of the service was framed in these terms, it was acceptable to Erich as and he was able to resume his trips to the German Club.

FOOd FOR ThOughT:• In the example above, Erich gave a false reason for not wanting to have a respite carer.

How would you identify if a reason wasn’t the truth, or was only a fraction of the reason? How would you seek to open an honest dialogue about concerns?

• If you were working with Erich and Ursula, what would you do to build more links with their German community and heritage?

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Design19C O - d E S I g N f O r b O T h f O r m A l A N d I N f O r m A l r E S p O N S E S

What is an example of a situation where your needs were met through a combination of help from professionals and from family or friends?

In order to keep the person embedded in their community life, resources that the person can bring to bear will be utilised before or alongside agency responses. These resources can include the person’s own skills, family, friends or community networks.

the appReCiative Question the pRovoCative pRoposition

RationaleAny single individual is likely to have a broad vision and a range of needs that are beyond the purview of any one service and even beyond the funds that are available. Bringing informal responses to bear is one helpful strategy.

Definition

Service(noun) • a system supplying a public need such

as transport or communications; the action of helping or doing work for someone.81

ORIgIns OF ThE WORd ‘sERvICE’

About 1100 AD: ‘celebration of public worship’ from Old French servise ‘act of homage; servitude; service at table’. The meaning: of word as ‘act of serving, occupation of an attendant servant’ is attested from about 1200, as is that of ‘assistance, help; a helpful act.’ Meanings to do with ‘state of being bound to undertake tasks for someone or at someone’s direction; labor performed or undertaken for another’ are mid-1300.82

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• Work in a “power with” relationship to explore each of the needs areas of the person, with the person.

• Identify the range of ways that each need could be met.

•Make reference to the table in the Tools section.

• Together, identify the option that would best meet the need, being clear that the assumption that the paid formal specialist service can be a last resort.

An example: If an individual needs to have a tidy lawn, the options to meet this need could be by using:

• an unpaid informal response, such as family or a neighbour

• a paid informal response, such as paying the neighbour or a grandchild

• a paid formal generic response, such as by using a mowing business

• a paid formal human service, such as an aged care, disability agency

things to ConsiDeR

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OPERATIng RulEs undERPInnIng WORld-vIEW

People who rely on services are involved in defining the problem as well as developing and implementing solutions

Recognising that different people interpret situations differently, hold different values and have different investments in a solution, and seeing the goal as securing a shared commitment to action rather than enforcing a single “right” answer

Tensions and differences between stakeholders discussed openly

Recognising that the interests of professionals and agencies are not identical to those of service users, and that saying one thing to people’s faces while writing something else in a report is almost always in the interests of the professionals rather than of the person served

Focus on quality of life issues, not just on clinical or service issues

Humility about the role of services in people’s lives, and honest awareness in the quantity and limitations of what is delivered

Engagement of people who know and like the person Seeing people as part of a social network: and valuing the contribution friends and family as much as that of professional staff

Use of ordinary language and familiar settings as a deliberate strategy to reduce power imbalances.

Recognition of the games that people play to enhance distance and retain power

Engaging the wider community and viewing this as a resource, not a threat

Looking in from ‘out there’ as much as looking out from ‘in here’

A focus on gifts and capacities rather than deficits Actually believing that everyone has something to offer society

dImEnsIOn

Type of contract Formal Informal

Whether money is exchanged

Paid Unpaid

Whether the agency is one used by only vulnerable people or by other citizens

Specialists Generic

dIsTInguIshIng FEATuREs OF CO-PROduCTIOn83

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For years, many people have been concerned about the corporatization and professionalization of human service to others – and what that is doing to our neighborhoods, and families, and our citizenry. The idea that human needs

are usually best met by paid professionals is a new idea in the context of history, and there are some unwanted results.

One result might be that surrounding people with professional, paid service workers can drive out natural, freely-given relationships. That could be

because people think, “This person must be really different from me, need really different things, and I am not sure I can provide them as a neighbor,

or sister, or friend.”Or sometimes people might find it really hard to get “next to” people when they are surrounded by services and service workers. It can be intimidating.Another result is the “clientization” (I think I just made that word up) – in

which people come to see themselves and be seen as lifelong human service clients, which becomes life-defining, and also lucrative as a source of revenue

for others.All this is bad news, but I am having an uncharacteristic burst of optimism.

A great many exceedingly helpful and beneficial activities are free:Mindsets are free – this includes the expectations that we hold that those we serve have gifts which can be offered and are needed in everyday life.

Betsy Neuville84

Role ClaRityEnsuring the right response is arranged does not necessarily mean doing everything for the person. The adviser should check which things the person may wish to arrange for themselves, or which they would prefer family members or friends to do. The role of the adviser in these situations may be to provide information or resources to assist others to arrange supports.

Reflect on arrangements that you have put in place in the past. What examples (with the benefit of hindsight) are there where informal, unpaid, generic options might have been appropriate?

Hunter, S. and Ritchie, P. (2007) Co-production and personalisation in social care.83

DisCussion Question ResouRCe

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A N O T h E r S O N g T O S I N gGrant was in dire straits. He was the carer for his wife Jean who had been diagnosed with a terminal condition. He was struggling with the day to day care needs that were part and parcel of Jean’s current situation. Grant wanted to be free to invest as much time as possible being a loving husband to Jean while there was life to be enjoyed together.Grant and Jean had met years ago when they shared a love of dancing, fun and music. The dancing days had gone but the sparkle that danced between them when they were together was a testimony to a stunning relationship that had lasted the test of time.Music was still an integral part of their lives, in particular classical music that wafted from their home as one drew near. It was clear that if we could orchestrate a range of services including personal care, cleaning and some respite Grant would have a song in his heart.The services began and life took a harmonious turn where all needs seemed to be getting met – well almost. Grant was a professional singer but had put this area of his life on hold except for some solo engagements at his local church and he was missing this involvement. I felt that this could be easily fixed with some respite occurring on Sundays on a fortnightly basis, however there was a hitch. I discovered the local church wasn’t just around the corner but in fact was about a half to three quarters of an hours drive away which meant respite would need to be for about 2 and a half hrs and already the package was close to the maximum time allowance.After much digging and delving we found a volunteer service that was willing to come to the party on Sundays on a fortnightly basis. Grant could continue to use his gifts and feel secure in knowing Jean was cared for while he was out of the house. Jean and the volunteer became firm friends and played a variety of board games and enjoyed each other’s company. This arrangement continued until Jean’s condition deteriorated to the point where she could no longer stay at home. We then assisted Jean and Grant to relocate to the country where their daughter cared for Jean with the assistance of another country organisation who we brokered until Jean eventually became hospitalised. The music has faded somewhat from Grant’s life now that he has returned to his old unit alone. We have been able to support him as he faces life without Jean, his car and to a certain extent his daughter. I caught up with him the other day and I could hear ABC Classic FM resounding from his sound system – it played ‘All my life’s a Circle’ – quite fitting really now Grant is singing solo again.

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Design20C O - d E S I g N f O r A p O S I T I v E h O m E l I f E

What makes ‘home’ precious to you? What’s your experience of your own home life when you have visitors staying or strangers (like trades people) visit? How relaxed do you feel? What happens to your usual routine?

It takes conscious effort by a professional to assist a person to remain ‘king or queen of their castle’ and to be able to stay in their own home for the long term.

the appReCiative Question the pRovoCative pRoposition

RationaleWhile many of us can take the privacy and security of our own homes for granted, this is not the case for vulnerable people. Increases in dependency can threaten the long term security of staying at home.

Further, once a human service becomes involved, home can easily be turned into a work place.

Definition

Home(noun) • the place where one lives permanently,

especially as a member of a family or household; a place where something flourishes, is most typically found, or from which it originates.85

There is much homelessness in our society: the homelessness of the elderly person, the homelessness of the single man or woman, the homelessness of separated couples, and the enormous homelessness of the many who are

alone together. Henri Nouwen

things to ConsiDeR

• Think typical: Become more aware of why our homes are important to each of us, and what we do to ‘make a home’.

• Minimise the obvious signs of human service workers, for example pamphlets and files left on the dining table.

• Use behaviour that shows deep respect for the person’s ownership of their own space and possessions.

• Identify the roles regarding home and what it would take to meet their needs so that they can have a good home life now.

• At some stage, raise the question of long term-ness: what it would take for the older person to remain safe and secure at home until they die if that is their wish?

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Desleigh de Jonge and her colleagues86 did research to explore what, according to older people, was central to their experience of home. They found the following:

older people in this study stated that they were interested in the capacity of the house to support their many and varied occupations, particularly their ability to care for others. They also enjoyed the independence and autonomy that living in their own home afforded them. The location of the home in the community provided general convenience and offered opportunities for social connectedness. The home environment and the surrounding community also created an ambience and afforded people a particular lifestyle. The importance of the history of the home environment and the emotional connection

older people have with the dwelling was another prevalent theme.

Michael Kendrick87 outlines nine principles for agencies supporting people to live in their own home. Here is his introductory paragraph:

It is not always the case that what ordinary people may think of as a ‘real’ home agrees with what agencies and systems may think of as a ‘real’ home. This is because everyday people exist in the world of normative culture in which a home can mean much more than simply a place to live. A ‘real’ home is not solely one’s dwelling place, but rather a key crucible in life that helps sustain and uphold much that is deeply personal, private and intimate about us. It reflects our deep identity, values and preferences for a good life.

ResouRCes

If someone needs a lot of medical equipment at home, what can be done so that the person’s home isn’t turned into a hospital?

One of the ‘arts’ of working in someone’s home is to leave a small working “footprint”. What guidance would you give workers to help them achieve this?

DisCussion Question

Role ClaRityThe adviser’s role is likely to include facilitating the person in home roles, such as homemaker, neighbour, host, tenant, shopper or hobbyist. One of the challenges to the adviser is to have support staff members who do not treat the person’s home as a workplace.

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‘Having control over one’s home is under threat for many people. The sanctity of one’s home can easily be transgressed by service workers,

visitors and even by well-meaning strangers. A simple example occurs when a worker has a key to the person’s home, and uses that key to enter, without even knocking. For some people, there may be very

good practical reasons for this. Nevertheless, there is an impact on the spirit of home. People experience a change of feeling as suddenly the

person’s home becomes a ‘facility’. It is also too easy these days for one’s home to become a place where work-based health and safety

take prominence.’ Mike Duggan88

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Design21C O O r d I N A T E , r E S O u r C E A N d r E f E r

Think about a time when you needed to arrange an event (perhaps a wedding or birthday party) and had many different things to consider (such as venue, menu, invitation lists, decorations). How did you go about finding out about all the options? What helped you to coordinate all the elements to create the final event? Were there any people who were particularly helpful in this process? Why?

The adviser recognises that they are a part of a broader system of community resources and services that can assist the older person. They will utilise these resources to the benefit of the older person, and recognise the limitations of their own expertise. When referrals are made, the adviser will ensure that the person or their representative is well informed about the referral, has given their consent, and that relevant information is forwarded to ensure the person does not have to repeat the information provided to the adviser.

the appReCiative Question the pRovoCative pRoposition

RationaleNo one service can or should address all of the needs of a person. To be coherent, a service will be competent at addressing one particular area of need. However, to ensure other needs are met, services must work together, with the person at the centre, to determine who can best meet the different needs of the person while sharing the common goals of the person/family. An adviser may need to consult another service that has special expertise in a particular area (e.g. working with people with Dementia).

Where the service recipient requires more than one service these should be provided in a continuous fashion, with good coordination. Relevant service workers need good relationships and communication between services.

Definition

Coordination(noun) • The harmonious adjustment or

interaction of parts.

Synergy(noun) • The interaction of two or more agents

or forces so that their combined effect is greater than the sum of their individual effects.89

Synergy — the bonus that is achieved when things work together

harmoniously. Mark Twain

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Questions to be considered when seeking the ‘right’ response for a person include:

• Is the response the most typical way to meet this need?

• Does the timing of the services meet the person’s lifestyle and needs? (for example being assisted to shower and dress in time for important social activities).

• Is the worker selected an appropriate match in terms of personality, cultural background and other factors? Has the service user been involved in the choice of care worker?

• Have you introduced the support worker to the person and explain their role?

• Does the support worker require training or credentialing for any of the tasks they are required to perform?

• If involving volunteers, are they are clear on their role, what tasks are required of them and the service’s expected behaviours?

• Think about higher order needs (such as spiritual and emotional needs) that go beyond the practical support requirements. How could you assist in meeting these needs?

The agreed assistance should be documented in a plan. This should describe not only what is to be done, but explain this in the context of the goals that have been set, and also include how the person would like the task to be completed.

sERvICE COORdInATIOn PRInCIPlEs

The following principles underpin good coordination between services:90

A central focus on consumers: Service delivery needs to be driven by the needs of consumers and the community, rather than the needs of the system, or those who practice in it.

Partnerships and collaboration: Service providers work together and take responsibility for the interests of consumers, not only within their own service but across the service system as a whole, including General Practitioners and Allied Health professionals.

The social model of health: A distinct conceptual framework for thinking about health. This framework is concerned with addressing the social and environmental determinants of health and wellbeing, as well as biological and medical factors. This includes the spiritual and family connections that contribute to wellbeing.

Competent staff: The elements of service coordination must be undertaken by staff who are appropriately skilled, qualified, experienced, supervised and supported.

A duty of care: A duty to take reasonable care of a person. The duty of care extends to Service Coordination, where staff have a duty of care to provide accurate and timely information, and assist consumers with referrals.

Protection of consumer information: improved information management practice is critical. Consumer consent and information about privacy requirements are designed to improve information flow, practice and consumer outcomes.

Engagement of other sectors: service coordination embraces the broadest range of partnerships across service provider types (small, large, non-government, government) and across disciplines, including general practice.

Consistency in practice standards: Service coordination enables services to remain independent of each other as entities but work in a cohesive and coordinated way to ensure that consumers experience a seamless and integrated service response.

As an adviser who is using a strengths-based approach with people, how could you work well with other parts of the system that focus on deficits and require people to be as frail as possible in order to qualify for additional supports?

DisCussion QuestionRole ClaRityThe adviser’s responsibility does not end when they have sent a referral. It is important to follow up the outcome and suggest alternatives if the referral isn’t accepted. The adviser needs to be the pivotal connector of all the different services, ensuring no duplication. Their role is also to follow through on any specific ways in which services should be provided in order to maintain independence.

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Design22C O - d E S I g N f O r C O m m u N I T y p A r T I C I p A T I O N A N d I N f O r m A l N E T w O r k S

Think about a time when you were warmly welcomed into a new group or returned to a group that you had not been part of for a while. What was special about the way that people behaved? How did it make you feel?

The adviser will recognise the potential value and effectiveness of both formal and informal supports. The service takes care to preserve and enhance informal supports from family, friends and generic community resources and will not replace these with formal supports.

The adviser recognises the value and importance of being pro-active in facilitating the successful use of relevant generic community resources by service recipients.

the appReCiative Question the pRovoCative pRoposition

RationaleIn the Discovery phase, the adviser has identified the important networks and community links that the person wishes to maintain or develop. The challenge in the Design and Delivery phase is how to bring this about. There can be many barriers to community participation, both in community attitudes and in practical areas such as transport and accessibility of community venues. Positive community participation helps to break down stereotypes and increase community understanding of older people. The continued segregation of any group of people who have become isolated will reduce their acceptance by the community. We have already discussed how personal relationships are beneficial for a person’s health.

Definition

Network(noun) • an association of individuals having a

common interest, formed to provide mutual assistance, helpful information, or the like.91

Social Capital(noun) • a sociological concept used to describe

the connections within and between social networks with the aim of highlighting the value of such networks to individuals, the community and the economy.

Putnam92 speaks of two main components of the concept: bonding social capital and bridging social capital. Bonding refers to the value assigned to social networks between homogeneous groups of people. Bridging refers to that of social networks between socially heterogeneous groups. Typical examples are that criminal gangs create bonding social capital, while choirs and bowling clubs create bridging social capital. Bridging social capital is argued to have a host of other benefits for societies, governments, individuals, and communities; Putnam likes to note that joining an organisation cuts in half an individual’s chance of dying within the next year.

There can be no vulnerability without risk; there can be no community without vulnerability; there can be no peace, and

ultimately no life, without community. M. Scott Peck

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In order to support the involvement of informal networks, advisers need to:

• demonstrate an awareness of the right response to each specific need (ie. a formal/informal, paid/unpaid, generic/specialist response)

• honour and value the contribution of family, friends and informal networks

• find ways to maintain and promote involvement by informal networks

• provide information about community activities and opportunities to experience different activities

• follow up on people’s interests, gifts, talents and aspirations

• consider reconnecting with past friends and associates identified in the discovery phase

• arrange practical supports to facilitate participation, such as transport and/or financial assistance

• ensure service arrangements (such as the provision of personal care) are able to be provided in a timely manner to enable involvement in community activities

• provide the personal support and encouragement required to facilitate participation in ways that counteract negative community perceptions

• seek out companions to accompany people on activities

• work with community groups to encourage understanding and acceptance of people who are frail or have cognitive impairments

• choose care workers who can role model positive interactions in community activities

• create opportunities and facilitate connections, then step back and allow them to take their course.93

Stanley and her colleagues, in researching the experience of loneliness in older people, found that there were dimensions of loneliness, and that it was important to understand which form(s) an individual might be experiencing in order to be able to respond to their loneliness. They said:

our findings show that loneliness is influenced by private, relational and temporal dimensions and whether older people feel that they have, or are seen by others as having, a sense of connectedness with the wider community. Participants expressed

the importance of maintaining social contact and having a sense of connection and belonging to the community.97

The private dimension of loneliness is reflected in the shame and stigma often attached to loneliness, such that an older person might not want to admit they are lonely. The relational dimension reflects the importance of having a range of relationships, from intimate relationships to social contacts. Experiencing a sense of belonging to people or place is part of the connectedness dimension. The

Community inclusion can be like an “iceberg”, where being in the community is only the tip of the iceberg. This is presence, where I see others and I am seen. Beyond that is participation – where I know others and I am known. At the deepest level is belonging – where I miss others and I am missed.94

To understand belonging we need to consider a number of aspects:

Location – where are the places that a person relates to?

Identity – what are the roles that are important to the person?

Interests – what are their interests and passions?

Personality – people like to belong in different ways. Some prefer a structured setting while others like to be informal.

While it is important for people to be able to go out into the community, for some people their restrictions may be such that we need to build a community around where they are.95

Participation, including participation in social activities, is central to older adult’s view of what constitutes successful ageing.96

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ResouRCes – ConTInueD

temporal dimension is reflected in situations where there are certain times of the day or years where the feeling of loneliness is experienced. Loneliness may be part of transition points in people’s lives, which refers to the re-adjustment dimension.

How an adviser might respond to loneliness will depend on what was explored during the Discovery phase in terms of the person’s experience and what is important to them. For example, studies of older people over a seven year period by Dykstra and her colleagues found that the experience of loneliness

by older people was bettered by assisting them to increase their functional capacities and helping them to expand their networks. This research also found that people did not become less lonely in nursing homes.98

Other relevant research was done by Litwin and Shiovitz-Ezra who found that it was the quality of relationships, not the quantity that was significant for many older people, when being engaged in activities.99

What should young people do with their lives today? Many things,

obviously. But the most daring thing is to create stable communities in which the terrible disease of

loneliness can be cured. Kurt Vonnegut, Jr.

How do you support someone who seems to have few networks and contacts to develop new relationships?

DisCussion QuestionRole ClaRityAn adviser can take on the role of community connector, or link the person with someone who is good at connecting. The adviser can identify opportunities and links that may increase opportunities to participate in the community and build relationships. Most importantly, the adviser and the services provided should not be a barrier to this occurring.

f r I E N d S h I pThe bonds of friendship waver tenderly in the wind People who come into our lives for a reason, a season or a lifetime Never knowing which one they will be, or which one we will be Waiting in the wings to share our dreams, our lives, our losses Stepping in when they see us falling or hurting Jumping high for joy with us when we celebrate Never doubting us.

Wanting to spend time in the arms and hearts of each other Knowing when to back off, when to come closer Nearby in times of grief, even when there are no words A hug, a kiss, a healing glance, somewhere to land a broken heart When there are no songs or conversations They stay comfortingly close by with friendship and love To help you mend a broken heart

By Kate Swaffer (2013)

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g O I N g S w I m m I N g l y !Donald is a 74 year old man who has led a very active life, his social life included weekly golf (winner of numerous trophies), swimming with four lifelong mates and he also travelled overseas every two years on fishing trips.

As a father he was actively involved with his children’s sporting and dancing interests. Donald was, and is, a fit and active man. He worked for over 50 years on the rail way in varying capacities. Upon retirement Donald continued his busy life with golf, swimming and fishing.

Two years ago Donald’s life changed with the onset of dementia. Donald was unable to do and be all that he was. He was very frustrated with the knowledge that he could no longer drive or participate in his passions of life. Donald was aware of the impact the dementia was having on his wife, as her time was spent ensuring Donald’s wellbeing and safety. Donald, seeing what his life was, surrounded by his memorabilia and memories became frustrated and agitated expressing this verbally.

Donald wanted to be able to do something physical and maintain his health as best he could. It was at this point that he was introduced to the community liaison worker. Donald, his wife and the worker discussed Donald’s need to be physically active, whilst being aware of the challenges and possible dangers Donald faced. Donald said that he really missed swimming. His wife said that two of his old swimming mates were no longer alive, and that contact with another was seldom, and the fourth friend had moved interstate.

Donald and the worker decided to go to the swimming pool where Donald had swum for many years. Although Donald’s memory wasn’t serving him very well he was able to swim lap upon lap and enjoyed it greatly. Donald and the worker joined in with the senior swimming group, Donald was able to have social contact with people of his own generation. The acceptance and support of many of the group enabled Donald to attend swimming on a weekly basis. As Donald began to engage with fellow swimmers the worker was able to facilitate a network of support for Donald including transport and supervision in a sensitive and appropriate manner. Even though Donald quickly forgot who he was speaking with, he had a sense of belonging by participating in what had been a life activity.

FOOd FOR ThOughT:• If you were working with Donald, how

could you prepare the swimming group to support Donald if he became disorientated and distressed at a class?

• How could you support Donald to stay involved in his children’s love of dance?

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T h E S T r E N g T h O f C O m m u N I T yA 90 year old lady, Mrs Smythe, lives alone and has a diagnosis of dementia. She has been a widow for 10 yrs. Her “younger” brother (who is 85 years old) also lives alone in a neighbouring suburb. Her brother is her main carer and still drives. Together they do most things such as shopping, attend church, paying bills. Mrs Smythe also attends regular church activities including the weekly drop-in group.

Mrs Smythe has been cautious of accepting “services” into her home. By using a gentle and sensitive approach she and her brother have become comfortable with the regular contact and involvement of their Coordinator. Up until now they have rejected the offer of other practical assistance. The major concern is how she will manage if there are any problems with her brother’s health. The program pays for fortnightly homecare, plus occasional extras e.g. an electrician to move power points in the bedroom to an accessible height. This will reduce the risk of tripping over numerous power leads.

During one visit Mrs. Smythe did express an interest in joining an exercise group. The Coordinator researched groups that operated in her area. All of the options were discussed at a home visit. She chose a local group at a neighbourhood house. Mrs Smythe did not own a pair of track suit pants so she had to go out and purchase a pair. Her Coordinator reminded her to do this and her neighbour took them up for her.

A care worker was arranged, carefully chosen for their knowledge and experience of working with people with dementia. This worker was to transport and accompany Mrs. Smythe to her Strength Training Group. It took three attempts to get her to the first group. She kept forgetting, had a doctor’s appointment, and then didn’t feel well enough to go. With the assistance of her brother giving her a reminder call early on the day, the worker giving her a call an hour before she arrived, and the cooperation of the G.P. signing the medical release she finally attended!

At her first class the whole group gave her a round of applause when they learned of her age! Mrs. Smythe is also building a trusting relationship with the worker, who will be able to assist in other ways when or if the need arises.

FOOd FOR ThOughT:• If you were working with Mrs Smythe, what planning and preparation would you do to make

sure that Mrs Smythe could continue to attend the exercise workshops with or without you?

•What steps could you take to support the relationship between Mrs Smythe and her brother?

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Design23C O - d E S I g N f O r b u I l d I N g C A p A b I l I T I E S

What was it like when someone believed in your potential, even if your potential wasn’t very obvious?

What ways (other than formal education), have you learnt and grown?

Strengthen a person’s skills at home and in the community and enable them to make decisions, and they will gain control and build independence.

A person and/or their ally may need assistance to fulfill their natural, personal responsibilities. This could include having a vision for a positive future, or being able to approach generic resources for assistance, negotiate what they want control over, and being able to fulfill their responsibilities. For example, they may need assistance to be able to describe what sort of staff they would like or to give feedback to staff.

the appReCiative Question the pRovoCative pRoposition

RationaleThe person may appear to have low self-expectations or low expectations of life. Their level of dependence might make it difficult to imagine how they could make choices/decisions about, and be in control of, their life.

Even so, it is important to believe that people can learn and that others will assist them. If an adviser believes this, then you are in a position to truly build capacity.

While generally it is a good to assume that a person ‘is an expert’ in their own lives, some people need help to make decisions that enable them to thrive rather than merely exist.

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Leadership is not a magnetic personality - that can just as well be a glib tongue. It is not ‘making friends and influencing people’ - that is flattery.

Leadership is lifting a person’s vision to higher sights, the raising of a person’s performance to a higher standard, the building of a personality

beyond its normal limitations.Peter Drucker

Definition

Capacity building(noun) • planned development to increase

knowledge and skills.100

Capability(noun) • the power or ability to do something.101

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The purpose of capability building is to increase the knowledge and skills of the person (and/or ally) so that they can be an informed and effective partner with the service.

Consider what sorts of hopes the person has for the future. To what extent have they settled for a very limited life? What would it take to raise their expectations? What are they open to being engaged in? For example, are the open to conversations? If so, who with?

Explore the question with the person and/or family/allies about what they would like to have a greater say over. The options could include:

• what they would like life to look like in the future

• what they feel they need in relation to what is important to them and what is important for them

• what planning is done

• who could be involved to help make the ideal future happen

• if support workers are likely to be involved, consider getting the person, family or allies to advise who they might be, how they might be recruited and supervised, what they might do and when they might come.

After identifying these items, explore what it would take for them to feel more confident (through being more competent) in these areas.

If you notice that the person is deferring to you as the professional, open a conversation about what it would take for them to feel confident in making the decision.

Reflect on and challenge what your team assumed was possible and continue to build and push capacity so that people can be actively involved in the co-design and co-delivery of their own supports.

It is possible to strengthen capabilities through engaging people with:

•information

• reading and/or hearing positive stories and examples

•technology

•written materials

•mentoring e.g. by another older person/ally

•training.

The Better Practice Project. (2012) Positive ageing stories and images.102

Ottmann G ed. (2013) Bouncing Back Later in Life: On How to Age Well and Overcome Difficulties.103

Robeyns I (2011) The Capability Approach. The Stanford Encyclopedia of Philosophy.104

What are some characteristics of people that you feel may be challenging to create an equal partnership with? For example, people with low education or cognitive impairments?

If you notice that the family is making decisions even though the older person might be able to themselves, how could you raise this in a respectful and non-threatening way? How can you facilitate a conversation between the older person and family so that it is their issue and not yours?

DisCussion Questions

Role ClaRityBuilding capability in a person leads to independence, good health, choice and control and is central to the role of the adviser. The adviser could have a lead role in capability building, such as through being an educator, storyteller and informer. The adviser may also engage other people with expertise to take on such roles, such as a physiotherapist or dietician. The adviser could also connect the person to a mentor.

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It is important for advisers to understand the range of emotions present with grief and loss, whether it is an older person grieving a spouse, the need to leave their home or their own feelings when ending a support relationship or a loss. Stages of grief have been identified, but current thinking indicates that these can be fluid rather than sequential, and people may move in and out of these emotions. These emotions can be considerable, but are a normal part of the grieving process. 105

sTAgEs OF gRIEF

•Shock

•Emotional release

•Isolation and depression

•Physical symptoms of distress

•Inability to cope with life

•Sense of guilt

•Anger and resentment

•Inability to return to normal activities

•Gradual awareness of reality and return of hope

•Adjustment to reality

Design24r E S p O N d I N g T O A p E r S O N ’ S g r I E f

Have you ever lost anyone close to you? What was it like when someone assisted you to continue with life after the loss of someone close to you? What things helped?

Acknowledging the realities of sorrowful experiences and providing appropriate support can assist people to continue to live life, despite a heavy heart.

the appReCiative Question the pRovoCative pRoposition

RationaleOur Western culture is typically uncomfortable with stories of loss and death, yet advisers work with many people for whom loss and death are realities. Engaging with these topics can be done sensitively and encouragingly.

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Definition

Sorrow(noun) • a feeling of deep distress caused

by loss, disappointment, or other misfortune suffered by oneself or others

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Some of the most important needs of grieving people include:

• To feel supported: We need to recognise that loss raises all sorts of feelings and that to cope people need the care, love, support and understanding of others.

• To face reality: The process of recovery is linked to acceptance of the loss. Acceptance will not come until reality is faced.

• To express feelings (emotional release): It seems important that people experiencing grief and loss should be helped, encouraged and allowed to express their feelings. This may be through tears and talking. Too often “would be helpers” suppress, rather than encourage and facilitate, emotional release.

• To allow space. We must recognise that being upset is healthy and helpful rather than harmful

• To move towards the return to normal daily life (re-establishment of ongoing living. For many this is difficult, and for a period of time (often many months) painful and unthinkable.

The extent of someone’s grief will be influenced by the situation, the nature of the relationship and many other factors. There is no magic time period when someone’s grief will be resolved. However, if you are concerned that a person is experiencing an abnormal grief reaction, you should involve a counsellor with expertise in this area.

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What could you say to a person who is living with grief and makes decisions that narrow their lifestyle, for example, by not eating or going out? How would you approach this conversation?

DisCussion Question

Role ClaRityIt is likely that the adviser would respond to issues of grief and sorrow when they impact on the needs and strategies within the Coordinator’s purview. It could be necessary for the adviser to receive support to be able to respond well. The person might also agree to being referred to a counsellor for additional support.

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Design25A d v O C A C y A N d S A f E g u A r d I N g

Think about a time when you felt unable to stand up for yourself, and were reliant on someone else to advocate for you, perhaps because you were unwell, or you did not understand the area (eg a complex legal process). What was helpful to you in that situation?

Where possible, the person should be encouraged to advocate for themselves, and to access external advocacy services or informal personal advocacy support. In implementing the agreed plan, an adviser may also need to advocate on behalf of a person to gain access to the services or the supports they need. If a person is very vulnerable or has a cognitive impairment, the adviser needs to put in place relevant safeguards to protect the person from harm and potential exploitation.

People will also be encouraged to express their views about the quality of the services they receive, and the adviser will act on this feedback.

the appReCiative Question the pRovoCative pRoposition

RationalePeople in receipt of services can be at risk of losing their autonomy and having their basic rights taken away. This is particularly the case where a person loses some of their cognitive abilities.

Many service users feel that they should be grateful for the service provided and are afraid to complain for fear of losing help. Opportunities need to be provided for service users and their families to be involved in the evaluation of the service to enable quality improvements that are most relevant to service users.

A powerful safeguard for any service recipient, especially when they are vulnerable, is the presence of at least one independent party (quite often in the form of a freely given relationship). The independent party then represents the interests of a service recipient as if those interests were their own. In the cases where an independent party isn’t available or one of the parties needs external advice, there are also formal advocacy services.

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Definition

Advocacy(noun) • the act of pleading for, supporting,

or recommending; active espousal.

Safeguard(noun) • something that serves as a protection

or defense or that ensures safety; a precautionary measure. 106

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The respect for the autonomy and rights of service users will be demonstrated by:

• encouraging people to make their own choices and allowing the dignity of risk

• upholding the rights of service users to the extent that is culturally accepted

• assisting and supporting service users to responsibly exercise their rights, enabling access to advocacy services and having appropriate and effective internal complaint mechanisms

• ensuring service recipients are informed about relevant advocacy bodies

• being open to the involvement of such parties by reducing unnecessary blocks to advocates having information (and unhelpful confidentiality procedures) and ensuring that information on important meetings is made available well in advance

• listening to and acting on reasonable requests and recommendations from advocates

• seeking advice from statutory bodies in situations where the competence of the service recipient to make critical life decisions is questioned

• seeking opinions, comments and critique from external sources (e.g. academic sources, consultants, external evaluation teams).

Safeguards can be:

1. Preventative: designed to prevent any harm coming to a person (e.g. careful planning that takes into account the risks or vulnerabilities of the person)

2. Developmental: develop/ enhance people’s capacity to prevent harm (e.g. educating or informing a person about options)

3. Corrective: actions and features designed to remediate and control occurrence of harmful effects (e.g. complaints or appeals mechanisms).107

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How do you encourage a person to express an honest view about the services they are receiving, especially when they seem concerned about the possibility of losing the service if they seem ungrateful?

DisCussion QuestionRole ClaRityWhere you see a pattern in the unmet needs or issues experienced by the people you are supporting, you may have a role in advocating at a system level rather than an individual one. You could bring this to the attention of your manager with some suggestions about what you think could be done to help prevent these situations occurring in the future (for example a change in policies or procedures).

“Education is a better safeguard of liberty than a standing army.”

Edward Everett Hale

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If some administrative and organisational processes are identified by a person (or their family) as being a barrier, what would you do?

DisCussion Question

Role ClaRityWhile the service environment is becoming increasingly bureaucratic, it is possible for the adviser to be a buffer between the person and the bureaucracy. This allows the adviser to maintain a commitment to the person and meeting their needs.

Design26d E v E l O p h E l p f u l A d m I N I S T r A T I v E A N d O r g A N I S A T I O N A l p r O C E S S E S

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Contrast your experience of dealing with a business with rigid rules and faceless staff, to a business where the workers are personable and the rules are transparent and flexible.

An agency can be accountable and viable, and still have administrative, financial and human resource systems that are designed to be individualised. This flexible structure will enable futures, home lives and community participation and create levels of choice and control that an older person can commit to.

the appReCiative Question the pRovoCative pRoposition

RationaleAdministrative – organisational processes can either help and facilitate, or create barriers to:

• people having the levels of choice and control that they would like

•flexibility and creativity

•timely responses.

Definition

Examples of administrative and organisational processes that help or hinder work with older people:• The organisation’s vision – does it supports

personalised responses, choice and control?

• How the budgets are done - do they allow the workers to be responsive?

• How intrusive bureaucratic processes are - are they creating barriers to accessing the service?

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Explore with the older person what things they would like more to say over, and how they would most like them to work.

Reflect on the agency’s procedures:

• What procedures facilitate individual responses? What procedures create barriers?

•What could be improved?

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Deliv

erw O r k I N g T O g E T h E rAlan had been a teacher and High School Principal for over 40 years. He really enjoyed his retirement. He played golf, and was active member in 11 organizations, (a hard working volunteer in half of those) and was a keen supporter of his favourite football team, the Broncos. He became ill on a cruise to New Zealand. His health deteriorated and he was assessed as eligible for a high level home care package. He was 80 years old. Annette, Alan’s wife was a pharmacist and stopped practising when Alan was given less than 6 months to live.Their initial experiences with a home care provider were just satisfactory. So they set about to change providers. Annette and Alan considered that they were very lucky to be allocated a home care package with a caring provider (who happened to involved in the pilot Consumer Directed Care program)! This new provider gave them proper equipment, shared information and generally made Alan’s life more comfortable. What a relief they felt!The monthly statement arrived, detailing income, expenses, unspent funds and contingency fund balance. Services weren’t changed, but they could see the unspent funds accumulating. This gave them a warm feeling knowing that if Alan needed anything (within the guidelines), they could ask for it and it would be approved.Alan was able to see his wonderful dietitian again (this had been denied to him by the previous provider).The new provider paid on invoice for the service. Alan was able to have the same care worker for respite (again from his chosen provider). Hire equipment was organized by the provider when they had a few days away at the beach, and they knew that while they were away, they could get respite and all the services they needed (within the package). They were given taxi vouchers to travel to the specialists in the city which had previously proved to be difficult and very stressful!When Alan was seriously ill, Annette asked for 24 hour support for 3 days and the provider agreed and organized this. This meant that she wasn’t alone and could get some sleep.Annette has been involved with their provider as they have been working through the implementation of Consumer Directed Care. She was asked to comment on the original draft of the Home Care Package Guidelines, and worked closely with the provider on writing self-management guidelines. They had many meetings, often involving the accountant, and trialed various methods in obtaining supplies and services. All these discussions have been extremely beneficial to both parties.

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Deliv

er Identify how to empower, learn, andimprovise. Sustain what gives life.

The delivery stages (sometimes known as destiny) are not the roll out of a planned approach without change. Rather, they are a time of continuous learning, adjustment and improvisation while striving for the shared ideal. Sometimes we need to support others who are part of the design, to ensure that they play their part.

Learning about a person and planning appropriate supports is never a one- off event - situations change, goals are achieved and new aspirations arise. Remain open to learning something new. Be flexible and work with change, not against it. Use your creativity to improvise new ideas. Focus on empowering the person. Deliver exceptional service.

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Deliver27A g r E E O N T h E p A r T N E r S h I p T O A r r A N g E S u p p O r T S

Think about when a paid professional (e.g. a physio or chiropractor) was in charge of your care and was clear about what they as the professional would do and what your responsibility was. What was it like when both parties lived up to these expectations?

In a “power-with” relationship, the adviser and the person (and/or ally) have clearly defined, pre-agreed responsibilities. It is important to be clear about the responsibilities and also on any support necessary for the person and their allies to enable them to carry out their responsibilities.

The service will competently and reliably deliver or arrange the supports that have been agreed with the person, in line with the person’s preferences. Where circumstances arise that make it difficult to deliver the agreed supports (such as staff illness), the service will make every effort to make alternative arrangements and give adequate notice to the person of the changes.

the appReCiative Question the pRovoCative pRoposition

RationaleIt is important for older people and their allies to have a greater say in and control of their lifestyle and support arrangements than has occurred in the past. Not everyone will want the same degree of control - individual agreements should be negotiated about the level of control people want, and what responsibilities they need to meet.

It is a big step for many older people to accept support in their own home or to be part of community life because it signifies that they need assistance of some form. It is crucial that this support be offered and put in place in timely, responsible and respectful ways. The service is accountable to the older person for the quality of what is arranged and delivered. It is also important for the older person to not feel like they have lost control simply because they have accepted help. That is why the nature of the partnership is critical.

Definition

Ally(verb) • to enter into an alliance; join or unite.108

Expert(noun) • a person who has special skill or

knowledge in some particular field.109

Partnership(noun) • the state or condition of being a

partner; participation; association; joint interest.110

“With teamwork, any little contribution you make yields greater output when it

meets the contribution of others, and guess who gets the plus? Everyone in the team!”

Israelmore Ayivor

“It is an absolute human certainty that no one can know his or her own beauty

or perceive a sense of his or her own worth until it has been reflected back

to him in the mirror of another loving, caring human being.”

John Joseph Powell 93

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The service is to be clear about the range of things that each person can control or choose and aim for as many service decisions as possible to be negotiable. Vitally, ask the person what they would like to choose and control and always assume that they want the highest level of choice and control. Drop back from that level of choice and control only when the person feels they are lacking in capacity at this time, or they can’t commit to the accountability requirements.

Develop a written agreement on:

• communication processes (phone, email, weekly, etc.)

•who is doing what, when• how any funds will be spent, when statements of

expenditure will be provided to the older person•processes for working out problems• how monitoring of the workers’ performance

will be done.

In the delivery stage, ensure that:

• the goals relate to their bigger picture of what

they’d like their lifestyle to be•you translate the goals into a meaningful plan• you use tools and forms that support advisers

and allow each person to explore alternate service options

• informal responses (by family, neighbours) are utilised before responses by you or another service

• all staff members involved understand the identity of the person being supported, including precisely how their issues impact on them personally (e.g. how does the stroke impact on them on a day to day basis)

• you provide relevant training to staff that extends beyond the training that is about agency policies

• the person can easily understand any documents from the service

• the person’s preferences are included in any documentation (for example, preferences for making showering a dignified and pleasant experience).

DisCussion Question

tools

Who will you, the professional, partner with if the older person has a cognitive impairment?

The following are some questions for the adviser, to help reflect on the partnership.

To what extent do I as an adviser:

• communicate in a way that allows a person to identify their own problems and solutions (with or without my guidance)

•expect or assume that I have all the answers• have a mind that is busy identifying solutions

while I am trying to listen to a person• think that the person would not have capacity,

and nor would their allies, to have high levels of choice and control

• explore what the person can do to solve their own problems before offering service solutions.

Training and discussion topics that could help staff members to meet people’s needs and work in partnership include:

•the experience of ageing in today’s culture•the experience of disability in today’s culture• exploring the fundamental needs of the people

we serve•working in partnership with service users.

Role ClaRityThe role of adviser as ‘partner’ allows the adviser to bring their expertise to the relationship without having to be the only expert at the table - the person and their allies will also bring expertise. In an equal partnership, the adviser does not have to have all of the answers in the first instance as there is time and space for the dreams and issues to be explored.

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Deliver28 C h E C k I N

Advisers will maintain regular contact, at a time agreed with the person, to ensure that services are being provided as agreed and that the person is satisfied with the quality and reliability of services. Where issues arise, the adviser will follow up and resolve these promptly. Where goals relate to the support of informal networks or linking with community resources, the adviser will also monitor how these are going and work with the person to overcome any barriers that may arise. Formal reviews will also be held on a regular basis where all arrangements can be reviewed in a face-to-face meeting, and progress in achieving goals can be documented.

the pRovoCative pRoposition

RationaleThe process of supporting a person does not stop when goals are agreed or a care plan is written. Advisers need to ensure that the plan is being carried out as agreed, and that what is provided is what is really needed to achieve the agreed goals. The process of getting to know a person is a continuous one, and over time different needs and goals may become evident. Both ongoing monitoring and a formal review process are important in the delivery stage.

Have you ever started in a new and unfamiliar job and had a supervisor who checked in regularly to see how you were getting on? Did you have a formal review at the end of your probationary period? What was particularly helpful in this process?

the appReCiative Question

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ECk IN

things to ConsiDeR

In order to monitor and review the supports being arranged:

• ask what difference the service is making to their lives

• check if there have been any negative impacts as a result of receiving support

• rarely ask whether they are satisfied— the person could have low expectations or be fearful of retribution so be unwilling to say that they are dissatisfied

• check if goals have been achieved and whether ongoing support is needed, or whether a new goal or different types of support are required

• remember to involve relevant family members or advocates in a formal review process

• check with family members that they are happy with the roles taken on, whether they are feeling under pressure, or would like to re-negotiate their agreements

• provide information on any new resources that may be relevant for the person

• qualified interpreters should be used for any reviews involving a person whose first language is not English

• remember to check not only how your service is going, but also that other services you arranged or referred the person to are still being provided in a satisfactory manner.

tools

AIm CuRREnT sITuATIOn gOAl ACTIOns REsPOns-

IBIlITyTImE

FRAmEdATE ACTIOns

COmPlETEd OuTCOmE

life area

Go back to the goal setting sheet (see Topic 16) and add the information about the actions completed and the outcomes achieved.

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tools – ConTInueD

A QuICK glImPsE WhAT’s WORKIng WhAT’s nOT WORKIng

perspective 1

perspective 2

perspective 3

Helen Sanderson uses a simple tool to help the review process:111

By talking with the older person and others close to them (family or staff) you can gain a picture of what is going well and what needs to change by asking the simple questions:

DisCussion Question

You are working with a person whose first language is not English but their family insists that they can interpret for their family member at reviews. How do you handle this?

Role ClaRityJust as they are in the initial stages of getting to know a person, listening and observing are also crucial to the review and monitoring process. People’s behaviour and other non-verbal communication may tell you as much about how well things are going as what they actually tell you.

“Listening is a magnetic and strange thing, a creative force….When we

are listened to it creates us, makes us unfold and expand.”

Ueland

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Advisers will be ready to adapt to a person’s changing circumstances and use creative means to overcome any issues relating to ongoing support, or barriers to achieving the agreed goals. Bureaucratic processes will be kept to a minimum and advisers may need to encourage self-advocacy or advocate for the person to ensure that the support provided is meeting their needs and goals.

the pRovoCative pRoposition

RationaleThe monitoring and review process is designed to ensure that support is occurring as planned, but it is also likely to uncover some issues that need to be addressed. It is easy to provide excuses for any shortfalls — ‘that’s the way it’s done around here’, ‘the system doesn’t allow us to do that’ — rather than think of creative ways to meet the need. Systems can be challenged and creative thinking can find ways around perceived barriers.

Have you ever had your heart set on something and come up against a seemingly insurmountable barrier? For example, you have dreamt about a holiday and your passport is stolen or you miss your flight. Did you ever come across a person who helped you negotiate the system to get you where you wanted to be? What did they do? How did it make you feel?

the appReCiative Question

Definition

Flexible(adjective) • Responsive to change; adaptable.112

things to ConsiDeR

In order to respond flexibly to changing needs you may need to consider:

•if formal responses are not working, whether an informal response could be more appropriate

• if the reasons you have been given for something not being “allowed” are real, and if there are mechanisms for challenging the decision

•using creative thinking techniques to help overcome issues and barriers

•to continue to ground your responses in the needs and aspirations of the person

• involving the person and their networks in generating alternative ideas and advocating for flexible responses

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What are some ways to overcome service constraints due to the limits on available financial resources? How should an adviser respond if there is no more money available for a person’s support?

DisCussion QuestionRole ClaRityThe adviser’s role is to continue to stand by the person and find flexible ways to support a good life in the community and meet their most pressing needs. However, resources are not infinite so there is a need to be creative about different ways to respond, and to focus on the needs that are the most important to address.

OUr rEspOnsiBiLiTy

UsE JUDgEMEnT AnD CrEATiViTy

nOT OUr rEspOnsiBiLiTy

tools

ThE dOughnuT

You and your colleagues may have different ideas about what your core responsibilities are and where you can use creativity and judgement. In some situations this will not be problematic. However, if the differences are substantial, you may find it useful to carry out the doughnut exercise as a team of professionals to ensure the best use of available resources.

There are often not sufficient resources to provide everything that a person may need, so being clear about the core responsibilities helps to focus attention on priorities. Outside of that, there may need to be more creative thinking about ways to respond to needs. This clarity also helps people to be accountable. Where an issue is not the responsibility of your service, you may need to make a referral to another service or community resource.113

“Be clear about your goal but be flexible about the process of achieving it.”

Brian Tracy

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Imagine you visit a mechanic, and at the end of the work the mechanic says “I’ve assessed the problem and replaced the part and you should be fine”. When you drive away, you can still hear the knock under the bonnet. How would you feel if the mechanic focussed on output (the right part was ordered and put in) and you focussed on outcome (the car still makes strange sounds)?

In partnership with the person and/or ally, the performance of staff can be measured by the extent that the goals and desirable outcomes are achieved. The evaluation and monitoring can be done by the person and/or their ally with or without the service, depending on what was agreed.

‘Satisfaction’ is only one factor and is a relatively problematic factor.

the appReCiative Question the pRovoCative pRoposition

RationaleWhat we need to keep our eyes on is the difference a service makes in the life of each person, from the perspective of the person. It is very easy for well-intentioned professionals to be focussed on rosters, staff training and duty of care.

If staff members are honest and friendly, then the service itself might be assumed to be positive and effective.

However, other factors like positive attitudes, strengthening or maintaining independence,

respectful attitudes to the home environment, finding community connections and having appropriate role boundaries are more crucial signs of ‘good’ staff.

We need to consider that the attributes people value in staff vary for different people. This means that a staff member may work well with some people, and not with others. Being aware of this and playing to staff members’ strengths is vital.

Definition

Monitor(adjective) • to check, observe, or record the

operation of, without interfering with the operation, to supervise; observe critically.114

Criticism is no threat to your self-esteem or identity, but rather informs you.

Bryant McGill

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things to ConsiDeR

Determine with the person what makes an effective staff member prior to a staff member being put in place.

Work out with the person what they will do if staff member is performing well or underperforming.

Encourage each staff member to demonstrate:

• self-awareness of their effectiveness in enabling the person to stay in control of their own lifestyle and support arrangements

• not doing any more or less than is required by the person to maintain their own independence

• creative ways for the person to be more independent

• that they do not take away the roles of the family members or friends in the person’s life.

Consider how best to conclude the support arrangements: The adviser needs to acknowledge that although they are in a professional relationship, they may have come to know a person very well through supporting them over a period of time. As with all relationships it is important to have positive closure. If the person is moving on from the program, take the time to say goodbye and make sure all loose ends are tied up. If a person has had to move suddenly (e.g. to hospital), try to take the time to visit and say goodbye. However, as it is a professional relationship, make sure you do not make promises you can’t keep, such as promising to keep in touch. Remember that you have now completed the role you were asked to take on, and have carried it out to the best of your ability!

If the person says that they are satisfied with the quality of support, but you believe that the quality could be much better, how might you proceed?

Is it possible to create an accurate picture of the performance of staff if you never see them interact with the person they are supporting? What is needed?

DisCussion QuestionsRole ClaRityWithin the activities of monitoring, the adviser could be in the roles of negotiator, detective and evaluator.

Knowledge of the self is the mother of all knowledge. So it is incumbent on me to know myself, to know it

completely, to know its minutiae, its characteristics, its subtleties, and its very atoms.

Kahlil Gibran101

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Think of a time when you have dealt with a business — for example a bank. Did the organisation’s rules help you get good service or did they get in the way? In what way?

The administrative rules and practices of an organisation should facilitate meeting people’s need for a positive future.

the appReCiative Question the pRovoCative pRoposition

RationaleA helpful service’s core goal is to assist people to have a better life. To reach this goal, the service makes sure that administrative and organisational processes don’t get in the way.

Being conscious of any barriers to accessing the service caused by administrative and organisational processes is vital, so they can be addressed and minimised or even removed.

Definition

Barrier(noun) • anything that restrains or obstructs progress, access, etc; a limit or boundary of any kind.115

things to ConsiDeR

Once the support of a person through your service is in place, continually review the administrative processes. Use the following questions and talking points as a guide:

• What administrative and/ or organisational matters are hindering how well we can do our work? Consider things such as:

o administration forms

o assessment procedures

o intake procedures

o how the rosters are done

o whether staff members are rotated and the impact of a change of staff member on the person receiving a service

• What organisational barriers impact on the capacity of the person to gain and maintain independence?

• Review each independent barrier and assess if it needs to be in its current format. What modifications might be ideal?

• Negotiate with appropriate agency personnel to relax the rules that create barriers wherever possible.

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If you found out that the way rosters were drawn up limited the personalisation of the service and the ability to be flexible and creative, what could you do?

DisCussion QuestionRole ClaRityThe exercise of reviewing administrative and organisational barriers requires the adviser to understand the experience of the person receiving a service. It also requires a willingness to raise issues that might challenge the status quo.

“Where there is a will there is a way” is an old and true saying. He or she who resolves upon doing a thing, by that very resolution often scales the barriers to it, and secures

its achievement. To think we are able is almost to be so - to determine upon attainment is frequently attainment itself.”

Samuel Smiles

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Think about a time when something you were involved in finished and had a positive ending (for example, perhaps you left a job or graduated from a course). While many endings can lead us to feel sad, what made this situation a positive one for you?

Advisers will be clear from the first interaction with a person about the scope of the service and the criteria for the service eventually ending. When a review indicates that the service is no longer needed, the person is no longer eligible, or the person is seen to need a higher level of support, this will be discussed as soon as possible with the person and their family. They should be informed of other available resources and supports, and the process for accessing these.

Of course there may be many other reasons why a service ends, such as if the person is admitted to hospital or even dies suddenly. It is still important in these situations to seek positive closure. In the case of hospitalisation, the adviser can talk with the person and/ or their family and be clear about the ongoing role of the service, and refer them to other relevant supports if required.

the appReCiative Question the pRovoCative pRoposition

RationaleMost support programs have a specific purpose. People cannot necessarily be guaranteed of ongoing support if their needs and circumstances change. Advisers should also be aiming to increase a person’s independence through utilising a restorative approach and therefore be aiming to reduce the reliance on ongoing supports. As advisers you will build a positive rapport with people over time and it may sometimes be difficult to discuss the need to end the service. The more that these situations are discussed up front, the more realistic expectations may be about the ongoing role of the service.

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g r A d u A T I O N d A yMusic pervaded the air as I moved into the auditorium. The gentle, earthy sounds of pan-pipes seemed to seep into my mind and soothe my body as I sunk into a surprisingly comfortable chair. Huge arrangements of orchids caught my eye and I knew Jim would approve of this touch for his special day.

He had a passion for orchids; they were housed in his hot house at the back of his house and lovingly attended by him with just the right amount of fertilizer and water. It was right that the people in the know make this day as special as possible for Jim. Jim had the habit of making things right for others. The kids across the way who enjoyed endless treats, the neighbours who knew Jim would lend a bed for the overflow at their house for those special occasions when extra family needed shelter and his grandchildren who knew the generosity of his monetary handouts.

The chairs around me were filling up. Some people I knew; his son and daughter-in-law, his grandchildren (whose photos I’d seen on the fireplace) and his cleaner and her husband. Others I’d only heard about, so I played a people jigsaw in my mind, trying to fit particular people with the roles I thought they may have played in Jim’s life.

My mind was brought back to the present with the fading out of the music and the moving to the front of the people involved with the graduation

things to ConsiDeR

In order to bring the relationship between your service and the service recipient to a satisfactory end you will need to:

• ensure that you have been clear about service expectations up front

• explain clearly why the service is ending and what alternative supports are realistically available for the person

• make relevant referrals, provide all the necessary information and follow through

• celebrate achievements, particularly if the person has achieved their goals and no longer requires support

• provide feedback to the person about what you see as their strengths and achievements during the time you have known them

• acknowledge potential feelings of grief and loss if the service is ending due to a bereavement or crisis

• ensure that the service user has relevant supports to help them through this time.

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ceremony. We were welcomed with warmth and then told about Jim, his life and achievements. Many of the anecdotes I had heard before but some were new and I got a difference sense of Jim and what made him tick. Even his grand-daughter came forward and contributed to the ceremony, her words a special gift to her grandfather.

As graduation ceremonies go this was both touching and seeming right. Death, in the Christian sense, is the graduation from one life to another. Jim in his 92nd year had graduated well. Until his untimely death, he had remained in his own home. He had renovated his kitchen area so that it was new and functional. His garden was his pride and joy. Even with his knee replacements and walking frame he managed to potter, prune and take pride in its neat and tidy appearance. Home cleaning and shopping from Community Options, weekly meals from Meals on Wheels and transport from Veterans Affairs enabled Jim to live life to his satisfaction.

As long as Jim could watch his beloved sport, especially football and cricket in the comfort of his suede designer recliner, with a few sweet treats for good measure, he was content. Jim’s life had undergone many changes; from married to widower, from able bodied to tottery. However, in all the changes he had choices: his choices and that made the difference. From life to life. Jim graduated with honors.

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r E f E r E N C E S

FOREWORd

1. Hammond S and Hall J (2001) What is Appreciative Inquiry? http://www.thinbook.com/thin-books/thin-book-of-appreciative-inquiry.html (accessed 13.04.15)

2. Aged and Community Services SA/NT (2006) Better Practice Project Handbook. Adelaide. http://www.agedcommunity.asn.au/wp-content/uploads/2014/05/BPP-Handbook.pdf (accessed 13.04.15)

ABOuT APPRECIATIvE InQuIRy

3. Cooperrider DL, Whitney D, and Stavros JM (2008) The Appreciative Inquiry Handbook: For Leaders of Change, 2nd Edition. Berrett-Koehler Publishers, Inc. and Crown Custom Publishing, Inc. USA.

4. Hammond S and Hall J (2001) What is Appreciative Inquiry? (see 1)

5. Cooperrider DL, Whitney D, and Stavros JM (2008) The Appreciative Inquiry Handbook, p 16 (see 3)

6. Bliss Browne, Imagine Chicago (undated). What is Appreciative Inquiry? Her work can be found at www.imaginechicago.org.

TOPIC 1

7. www.merriam-webster.com (accessed 19.04.15)

TOPIC 2

8. Kendrick M (undated). Workshop Materials on Right Relationship (unpublished). Related work can be found at www.kendrickconsulting.org (accessed 19.04.15)

9. James Delrojo (2010) Six Tips for Building and Maintaining Rapport. www.enhancedhealing.com (accessed 25.02.10 – content no longer on the site)

10. Kendrick, M. (2000) Some Initial Thoughts on Establishing ‘Right Relationship’ Between Staff, Professionals, Service Organisations and the People They Assist. Newsletter: Queensland Advocacy Inc.. Brisbane.

11. Stirling, E. (2010) Valuing older people: positive psychological practice. West Sussex. Wiley-Blackwell. p71.

TOPIC 3

12. Skeie M, Skeie J and Roles J (2007) Mapping Your Retirement: A Personal Guide to Maintaining Your Health, Managing Your Money and Living Well. MYR Publications, USA, pp 19-21.

13. Helen Sanderson and Associates (2007) Person Centred Thinking with Older People: Practicalities and Possibilities. http://www.ndti.org.uk/uploads/files/PCPOPweb3.pdf (“Appreciations” at pp 21-26). See also www.helensandersonassociates.co.uk for other resources from Helen Sanderson.

TOPIC 4

14. McDowell D (1995) The Challenge of Meeting Individual Needs. Paper for the Aged Care Australia Conference, 9 November 1995, Canberra, p 220.

TOPIC 5

15. Lyons TR (2010) Strengths Based Social Work Practice. www.en.wikibooks.org/wiki/Strengths-Based_Social_Work_Practice (accessed 19.04.15)

16. www.dictionary.com (accessed 19.04.15)

17. UnitingCare Australia and Inspiring Communities (2009) Building Belonging: Celebrating Inclusive Communities. Asset Based Community Development Workshop Handbook, p 26.

18. E. H. Erikson et al (1986) Vital Involvement in Old Age. W W Norton & Co. NY.

19. St. Luke’s Innovative Resources, Bendigo. www.innovativeresources.org (accessed 19.04.15)

20. www.wikipedia.org (accessed 19.04.15)

21. Robbins R (1997) Unlimited Power: The New Science of Personal Achievement. Simon and Schuster. NY

TOPIC 6

22. www.dictionary.com (accessed 19.04.15)

23. Adapted from Antonucci and Akiyama, 1987 and Kahn and Antonucci, 1980 in Skeie M, Skeie J and Roles J (2007) (see 12), p34

24. Maori Proverb (WHAKATAUKI), FTM Aotearoa. http://maraemelbourne.net/our-peoples-dream/ (accessed 19.04.15)

TOPIC 7

25. www.dictionary.com (accessed 19.04.15)

26. Centre for Cultural Diversity in Ageing. http://www.culturaldiversity.com.au/resources/national-resources-search (accessed 19.04.15)

27. Aged and Community Services SA/NT. Better Practice Program (April 2009) Aboriginal & Torres Strait Islander Home & Community Care Workers Forum. Unpublished Proceedings. South Australia.

28. Benevolent Society of NSW (2013) Working with older Aboriginal and Torres Strait Islander people - research to practice briefing 8. www.benevolent.org.au/think/practice--resources

29. Goldsmith, M (1996) Slow down and listen to their voices. Journal of Dementia Care, 4 (4) 24–25 (1996) cited in the Centre for Cultural Diversity in Ageing website http://www.culturaldiversity.com.au/resources/practice-guides/dementia-care

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rEfErENCES

r E f E r E N C E S – ConTInueD

TOPIC 8

30. www.dictionary.reference.com (accessed 19.04.15)

31. Helen Sanderson & Associates (2007) (see 13)

32. J.R. Bradshaw (1972) The Taxonomy of Social Need in McLachlan, G. (ed), Problems and Progress in Medical Care. Oxford University Press, Oxford.

33. Wolfensberger W (undated) Universal Human Needs (workshop materials)

34. D de Jonge DM, Jones A, Phillips R and Chung M (2011) Understanding the Essence of Home: Older People’s Experience of Home in Australia. Occupational Therapy International. 18, p39-47.

35. Stanley M, Moyle W, Ballantyne A, Jaworski K, Corlis M, Oxlade D, Stoll A, Young B (2010) Nowadays you don’t even see your neighbours: loneliness in the everyday lives of older Australians. Health and Social Care in the Community (2010) 18(4), p407–414.

TOPIC 9

36. Loo T (2006) How to Define Your Life Purpose. http://ezinearticles.com/?How-to-Define-Your-Life-Purpose&id=331527 (accessed 19.04.15)

37. Back on Track (2014) Blog Posted on April 10, 2014 by elizabethneuville, Keystone Institute.

https://onbeingofservice.wordpress.com/tag/culturally-valued-analogue/

38. Adapted from Helen Sanderson & Associates, pp89,90 (see 13)

39. Kivnick H & Stoffel SA (2005) Vital Involvement Practice: strengths as more than tools for solving problems. J Gerontol Soc Work. 2005; 46(2): pp85-116.

TOPIC 10

40. Civic Ventures (2007) cited in Mark Skeie, Janet Skeie & Julie Roles (2007) (see 12), p 51

41. Thomas S & Dr Wolfensberger W (1999) An Overview of Social Role Valorization in Flynn RJ & Lemay RA (eds) in A Quarter-Century of Normalization and Social Role Valorization: Evolution and Impact. University of Ottawa Press, p 126.

42. Matthews (1996) cited in Mark Skeie, Janet Skeie & Julie Roles (2007) (see 13), p 51

43. Summarised from Ramsay S (2007) Roles Based Planning: A Thoughtful Approach to Social Inclusion AND Empowerment, 2nd ed. Anti-Marginalization Task Force, Calgary, AB. pp32,33

44. Better Practice Project (2014) Valued roles for all: The keys to a good life. Aged and

Community Services SA/NT. Adelaide. http://www.agedcommunity.asn.au/wp-content/uploads/2014/03/BPP_Handbook-for-web.pdf (accessed 13.04.15)

TOPIC 11

45. Carmichael (2006); Taylor et al (2000) in Skeie M, Skeie J & Roles J (2007) (see 12), p 32

46. www.thefreedictionary.com (accessed 19.04.15)

47. Australian Government (2010) Carer Recognition Act Cwlth 2010. http://www.comlaw.gov.au/Details/C2010A00123 (accessed 19.04.15)

48. Carers Australia. www.carersaustralia.com.au (accessed 10.06.10)

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57. Adapted from www.dictionary.com and Apple dictionary app.

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59. Adapted from www.dictionary.com and Apple dictionary app.

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64. http://www.oxforddictionaries.com/definition/english/community (accessed 21.04.15)

65. Neuville E. (2012) Small just might be beautiful. On Being of Service http://onbeingofservice.wordpress.com/2012/04/29/small-just-might-be-beautiful/ Posted on April 29, 2012 by Elizabeth Neuville (accessed 21.04.15).

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66. http://dictionary.reference.com/browse/creativity (accessed 21.04.15)

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71. www.dictionary.com (accessed 21.04.15 )

72. Wolfensberger W (undated) Workshop Materials

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73. Wolfensberger W et al, 3rd rev. ed. (2007) PASSING Manual: A Tool for Analyzing Service Quality According to Social Role Valorization Criteria. Training Institute for Human Service Planning, Leadership and Change Agentry, Syracuse University. USA. Definitions, p 30.

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78. Wolfensberger W et al (3rd Rev. Ed. - 2007) PASSING Manual: A Tool for Analyzing Service Quality According to Social Role Valorization Criteria. Training Institute for Human Service Planning, Leadership and Change Agentry, Syracuse University. USA. Definitions, p 30

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81. https://www.google.co.uk/search?q=define+service (accessed 21.04.15)

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83. Hunter, S. and Ritchie, P. (2007) Co-production and personalisation in social care. London: Jessica Kingsley Publishers, p17.

84. Neuville, E. (2012) The Flip Side of Fear – Possibility? Posted on On Being of Service: a blog by the Keystone Institute. June 13, 2012.

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85. http://www.oxforddictionaries.com/definition/english/home (accessed 21.04.15)

86. D de Jonge DM, Jones A, Phillips R and Chung M (2011) Understanding the Essence of Home: Older People’s Experience of Home in Australia. Occupational Therapy International. 18, p39-47.

87. Kendrick, M (2008) How Genuinely Supportive Persons, Agencies And Systems Can Enable People To Have Real Homes Of Their Own. CRUcial Times. 40, pp13-15.

88. Mike Duggan (2008) ‘What makes home ‘home’?’ CRUcial Times, Issue 40, page 3.

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89. www.dictionary.com (accessed 21.04.15)

90. Adapted from Department of Human Services Victoria (2012) Good Practice Guide: A resource

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91. www.dictionary.com (accessed 21.04.15)

92. Putnam R (2001) Bowling Alone: The Collapse and Revival of American Community. Touchstone, NY, pp 18-24.

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96. Buys & Miller (2006), cited in Bridget Ryburn et al (2008) (see xx), p25.

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99. The Better Practice Project. (2012) Positive ageing stories and images. Aged & Community Services SA/NT. Adelaide.

100. Adapted from www.dictionary.com and Apple dictionary app.

101. Adapted from www.dictionary.com and Apple dictionary app.

102. Ottmann G ed. (2013) Bouncing Back Later in Life: On How to Age Well and Overcome Difficulties. Connor Court, Melbourne.

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105. Better Practice Project (2006) Grief and Loss Workshop. Living as an Older Person Training Package. Aged & Community Services SA/NT. Adelaide. pp 45-50.

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106. www.dictionary.reference.com (accessed 21.04.15)

107. Kendrick M (2002) Intentional Safeguards for Older People. The New Zealand Council of Christian Social Services Conference: ‘Values: Cost or Investment’. Wellington, New Zealand 18-22, 2002. Conference Proceedings. www.kendrickconsulting.org

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108. Adapted from www.dictionary.com and Apple dictionary app.

109. Adapted from www.dictionary.com and Apple dictionary app.

110. Adapted from www.dictionary.com and Apple dictionary app.

TOPIC 28

111. Helen Sanderson & Associates (2007) Person Centered thinking with Older People. p 18. (see 113)

112. www.dictionary.com (accessed 21.04.15)

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114. Adapted from www.dictionary.com and Apple dictionary app.

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rEfErENCES

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COnTACT dETAIls Joyleen Thomas – Manager, Better Practice Project

Aged & Community Services SA & NT246 Glen Osmond Road, Fullarton SA 5063

T 08 8338 7111  F 08 8338 7077

W http://www.agedcommunity.asn.au/providers/better-practice-project/resources-publications/

E [email protected]


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