Task 1:
In your own words respond to the following questions and statements.
1. Outline your understanding of advocacy.
in an aged care context, means that the worker acts for and on behalf of the client
2. Why do you believe people with disabilities need advocacy? Give an example.
People with disability need advocacy because they do not always know their rights and options available to them. For example, a client might not know that they are legally entitled to an interpreter and hence not enjoy the sort of care that they are legally entitled to.
3. List 5 key elements or principles of advocacy.
• Assisting clients to identify their own needs and rights
• Meeting clients needs in the context of organisational requirements
• Supporting clients to ensure their rights are upheld
• Awareness of potential conflicts between client's needs and organisational requirements.
• Providing accurate information
4. Outline your understanding of each of these key elements or principles.
1. Assisting Clients to identify their needs and rights:
This implies that the care worker will make an assessment of needs and ensure that the clients are aware of their rights and entitlements and use this information to make value judgements needed to add value to the client’s care.2. Meeting the clients needs in the context of organisation requirements
The care worker works within the framework of the organisation they work for consequently a clients needs should be met without violating policies and procedures set out by the organisation
3. Supporting clients to ensure that their rights are upheld
The care worker will make known to the client their rights and will take necessary steps to ensure that clients make decisions in full knowledge of options and entitlements available to them.
4. Awareness of potential conflict between client’s needs and organisational requirements
A client’s needs might not fall within the obligations that an organisational is required to fulfil. Therefore, it is important to ensure that all needs are met within organisational practice.
5. Providing accurate information
Care worker will ensure that accurate information is gathered for the client to make informed decisions
5. Provide 2 examples of what is not considered advocacy and explain your reason.
Allowing a client to exploit you as a careworker such as sexually and allowing a client to abuse drugs are two examples of what is not considered advocacy. Client advocacy does not imply that the carer must let the client abuse them or abuse themselves hence the two above examples are examples that are not considered as advocacy.
6. Describe “self advocacy” and provide an example of when it would be appropriate for a person with a disability to self advocate and explain your response.
Self advocacy is an individual’s ability to effectively communicate, convey, negotiate or assert his or her own interests, desires, needs, and rights. It involves making informed decisions and taking responsibility for those decisions.
An instance when it will be appropriate for a person to self advocate could be when they feel that they are not adequately involved in the decision making of their care plan. Should this happen, my response would be to assess the client’s needs and wants and determine whether they fall within legal and policy obligations of the organisation. If they do, then I would continue to implement changes as advocated by the client.
7. Provide an example of when it would not be appropriate for a person with a disability to self advocate and explain your response.
It would not be appropriate for a person with say mental disability wants to stop taking medication. My response would be to inform the supervisor and contact family and doctor who will then advocate on behalf of the client appropriate action to be taken.
8. How would you support a person with a disability to advocate for his or her self?
By ensuring that they are updated with their rights and entitlements.
9. Briefly describe the different types of advocacy that are available to people with disabilities?
Self advocacy-This is speaking up for yourself
Peer advocacy -This is when the advocate and the advocacy partner share similar experiences or environments say live in the same nursing home.
Paid independent or professional advocacy-This can often be called crisis, issues based or case advocacy. It usually means that it is advocacy with clear outcomes and targets and the advocacy input finishes when the outcomes have been met. This advocacy can be undertaken by volunteers or paid members of local independent advocacy scheme staff or by individual paid consultant advocates.
Citizen advocacy
This is a partnership between two people. To try to make things clear, one is usually called the advocacy partner, and one the citizen advocate. An advocacy partner is someone at risk of having choices, wishes and decisions ignored, and who needs help in making them known and making sure they are responded to. A citizen advocate is a person who volunteers to speak up for and support an advocacy partner and is not paid to do so.
10. What is “conflict of interest”? Provide an example.
We can define a conflict of interest as a situation in which a person has a private or personal interest sufficient to appear to influence the objective exercise of his or her official duties as, say, a public official, an employee, or a professional. For example, if a client wants to go for a walk and I do not allow them to go for a walk because I am lazy and just want to sit and watch my favourite television program there is conflict of personal interest and the responsibility of a care worker.
11. How would you address a situation where you had a conflict of interest?
I would address it by acting in the best interest of the client.
12. What policies exist in the workplace relating to advocacy?
When a client feels that their rights have been infringed, they may need an advocate to assist or support them in addressing the situation. Whether the infringement is real or perceived, it still should be dealt with. For example, it their right to personal safety and security has been infringed, they have the right to protection and legal remedies.
13. How would you ensure you maintained client confidentiality when conducting advocacy on behalf of clients?
By ensuring that information is disclosed to relevant people only.
Task 2:
Read the following case study and write an Action Plan to address the advocacy needs.
Case Study 1
Arthur is 67 and has a mild intellectual disability. He wants to live independently but for most of his life he has lived in an institution.
Since the institution closed down four years ago he has lived in a residential setting with four other people. He enjoys reading and doing household chores and spending time with his sister and her family. You are a support worker in the residence and believe he could make a go of living independently with minimal support. The house supervisor disagrees with you and refuses to give it any consideration.
Content of Plan:
The needs and/or rights being infringed or not met.
Arthur has a right to live independently and this right should be respected as far as possible. By refusing to him to live alone, there is infringement of his need. The goal of this advocacy action is to demonstrate the plausibility for Arthur to live independently.
Arthur can be allowed to live by himself by first of all addressing his key areas of need. This will involve a full assessment of his cognitive ability, physical abilities and ability to integrate with society. From there on, Arthur can be increasingly trained to do more and more house hold chores by himself including his personal hygiene. Once we get to the point where development as far as possible, we can now assess the level of support that Arthur would need. It might be as well that Arthur’s family will be able to provide this support. This will require Occupational Therapist, psychologists, workers, nurses, doctors and legal guardian to make this decision.
An Occupational therapist will monitor and assess Arthur’s ability to live alone, psychologist will assess his mental well being while nurses will assess the medical support he will need. Carers will provide information about his behaviour and needs as witnessed from working with Arthur.
From here on, Arthur can go live with his family for a month with a care worker coming in during the day to provide assistance where necessary such as going shopping or doing community activities together. Once a month has passed, another assessment can be carried out to determine progress. If a sufficient level of progress has been made, Arthur can move out on his own and go live on his own with the support of a worker. Every decision point will involve Arthur’s input and his legal guardian to ensure that his rights and interests are protected. A family legal guardian will be pivotal in the decision making process because they will represent Arthur’s best interest.
If it turns out that Arthur cannot live as independently as he wanted, either more care workers support will be provided in his new home.
Monday, April 20, 2009
CHCAC3C Orientation to aged care work - Tasks
Tasks:
Element 1:
Demonstrate an understanding of the structure and profile of the aged care sector.
The aged care sector has policies and legislature that are aimed at protecting clients. It encourages client participation in drawing up a care plan or during interation with care worker.
Element 2:
Demonstrate a commitment to the philosophy of ‘positive ageing’
Funding to the tune $1.4 million dollars by the office of Senior Victorians to support the positive ageing project which aims to build the capacity of local government to plan for an ageing population. It also aims to provide leadership in promoting "age friendly" communities that create opportunities for senior Victorians to live active and fulfilling lives.
Element 3:
Support the rights and interests of older person
KEY ISSUES
1. Attach/describe a news item from television, radio, newspaper or magazine relating to older people.
The age-old quandary
The age-old quandary
By Karen Kissane
April 20 2002
You are 75. You break a hip in a fall and need surgery. While in hospital, you pick up a post-operative wound infection and develop pneumonia. Your forgetfulness intensifies into more serious dementia symptoms as you struggle to cope with the twin assaults of illness and a strange environment. You are now frail and will need weeks or months of care and rehabilitation; perhaps you will never go home again.
The hospital is not set up for convalescents and wants your bed for more urgent patients. Who will look after you, and how will it be paid for?
It is the kind of question that is central not just to your future but to Australia's, according to Treasurer Peter Costello. This week he warned cabinet of a $50 billion-a-year budget blow-out in health, aged care and income-support programs within a generation unless the sharply rising costs of a greying population are curbed. A visionary attempt to grapple with the future - or an attempt to soften up the public for cuts to Medicare and social welfare?
"This analysis is scaremongering designed to frighten people into accepting public sector budget cuts when, in reality, they are probably not going to be required," says Stephen Duckett, professor of health policy at La Trobe University.
But an administrator in a private hospital disagrees about the need for concern about the community's ability to pay for the needs of older people. "Future horror scenario?" she says. "The system has trouble coping with the elderly now."
In the next 40 years, the number of Australians aged over 65 will rise from 2.4 million to 6.2 million, with the proportion of older people doubling from 12 to 25 per cent. Towards the middle of next century, after the baby boomers have retired, there might be only 2.5 people of working age for every person over 65, compared to more than five people currently.
According to a report by Access Economics to the Federal Government, the number of workers and the level of income tax revenue is predicted to slow down from now; pension outlays will increase from 2010; health spending will rise from 2020; and aged-care demands will increase from 2030.
The figures sound daunting, and some researchers are warning about the necessity to budget for the needs of the elderly. Other analysts, however, say the outcome is unlikely to be dire, with many comparable countries already coping well with higher levels of older people. "Australia in 20 or 30 years' time is going to be like France is now," Duckett says. "We will be older, but we will be roughly the same as several European countries are now. These European countries aren't bankrupt, so what makes us think that we're going to be bankrupt?"
The current banner of the doom-and-gloom brigade is a landmark report due to be released by the government with next month's federal budget. The Inter-generational Report by Treasury's Retirement Incomes Modelling Unit is the first official government study of the future cost of current policies, and it predicts that advances in medical science that allow people to live longer will place a massive burden on taxpayers, mostly due to expensive new drugs and medical technology. The report is designed to trigger a public debate on the sustainability of existing health and aged-care programs.
News of the report came as the Myer Foundation announced a million-dollar project to develop a vision for aged care in Australia, and as the United Nations ended its world assembly on ageing in Madrid.
Greying is a global issue, says Professor Gary Andrews, of Adelaide's Centre for Ageing Studies, who attended the assembly. He says developed nations face a significant increase in the very old (those aged 80-90), but ageing is also relevant to the developing world. "Already in a country like China you have more than 100 million people aged 60 and over," he says.
While the details of the Treasury report are still under wraps, others have previously tried to estimate what ageing will cost Australia. Aged-care spending will more than double in real terms from 1997 to 2031, from $5.8 billion to $14.3 billion, warned a staff research paper by the Productivity Commission in October, 2000. But Australia will probably be richer and more able to afford it; even with relatively conservative estimates of gross domestic product, the report said, "spending grows by only about 25 per cent when expressed as a share of GDP".
The report, Long-Term Aged Care: Expenditure Trends and Projections, predicted that nursing home beds would need to increase from 78,600 to 158,500 in 2031. But, while the aged's health costs would rise in real terms each year to 2031, they would fall, relative to GDP, until 2021; by 2031, they will be 2.9 per cent of GDP.
Several health economists claim that the view of the elderly as a drain on health resources is wrong. Duckett has researched whether age is a factor in the cost of hospital stays, examining whether 70-year-olds cost more than 55-year-olds with the same condition. He found no systematic variation. "People think they should worry because older people stay longer, but in reality they often have substantially less investigation and interventions than younger people," he says.
Andrews agrees: "The fact that more people are in their 70s and 80s and 90s has a relatively small impact on total health costs. A lot of research in the past decade (confirms) less than 5 per cent of the increase in health care costs is accounted for by the population ageing."
Professor Jeff Richardson, of the Centre for Health Program Evaluation at Monash University, says it is not ageing itself that is the problem: "It's ageing plus new technology."
But another question raised by the Treasury report is acknowledged by many analysts as a problem: the ever-rising cost of drugs. John Goss, principal economist with the Australian Institute of Health and Welfare in Sydney, says: "The growth for the Pharmaceutical Benefits Scheme has been 9 per cent per year in real terms. If you have growth of 9 per cent, the doubling period is about eight years. It quadruples in 16 years, and it's eight times (higher) in 24 years. It has huge momentum."
An unknown factor in the future equation is the health status of the next generation of oldies. Does living longer just mean more years of disability and degeneration, or will increased life expectancy also mean more years of good health?
Duckett believes the latter. "The reason people are living longer is that they are healthier in old age. An 80-year-old in 20 years' time will be healthier than an 80-year-old today."
And it has always been the case that people usually chew up the largest amount of health care in the two years before they die, whether this is at 65 or 85, because that is when their health breaks down. "The general view across demographers and health planners is that the need for health care is not based on years from birth but rather is based on years to death," Duckett says.
There is another, gloomier possibility. People who live longer because of a reduction in one disease might contract another that disables them; if you avoid the coronary at 70, will you face dementia at 72? The Productivity Commission report says advances such as artificial joint replacements and improved treatments for osteoporosis, arthritis and dementia might lessen disability among the aged. But technology might also increase the survival time of people with disabilities, the report says. "Dialysis for renal failure increases survival time, but the aged person receiving such treatment will still typically be unable to perform many tasks unaided."
Then again, disability does not necessarily mean institutionalisation. The Productivity Commission estimates that, while about 18 per cent of those over 65 have a profound or severe disability, only 3 per cent of old people are in residential care.
For some people trying to care for the aged now, the question of whether the future poses problems is nonsensical. There is already a national shortage of nursing home and hostel beds, long delays for elective surgery and cancer treatments, and problems with elderly patients acting as "bedblockers" in acute hospitals (too sick to go home, but with nowhere else to go).
"An acute hospital is not a convalescent home for looking after elderly people when they are not acutely ill," says Denis Hogg, chief executive of Epworth Hospital. "But where do you refer them to for their on-going care?"
He denies that private hospitals cherry-pick to avoid bedblocking - "In our emergency department, 75 per cent of people admitted are over 75" - and he says Epworth has had to set up its own self-funded aged-care coordination team to try to find places for older people who need care following discharge.
"Step-down" care, between a hospital visit and home, is unfunded by private insurance and often unavailable, says Angela Magarry, director of policy for Catholic Health Australia. Like many other organisations, CHA wants aged care and health to be run by one level of government to prevent buckpassing of responsibilities and gaps in the system. CHA has also called for a Medicare "grey card" to be established to protect older people's right to care.
Denys Correll, national executive director of the Council on the Ageing, agrees that Medicare should be strengthened and says problems such as the blowout in pharmaceutical costs can be managed by price volume agreements between the government and manufacturers.
Goss points out that anxiety over costs tends to ignore benefits: "There's no need for doom and gloom if any increase in expenditure produces more benefits than costs in terms of older people being healthier, suffering less pain and having a lower chance of dying."
An extraordinary number of older people are involved in the informal economy through their care of grandchildren, he points out.
"There's often strong interests behind the position saying that 'the world is falling apart'," says John McCallum, professor of public health at the University of Western Sydney. He is concerned that an atmosphere of pessimism might encourage the belief that more health and aged-care services must be privatised if the government is not to go bust. In his view, "there are serious issues and they do have to be dealt with, but they're not necessarily going to break the bank or destroy the Australian way of life".
Karen Kissane is an Age senior writer.
This story was found at: http://www.theage.com.au/articles/2002/04/19/1019020708222.html
What issue is the focus of the item?
There is a general belief that older people are expensive to maintain and that as a result, they will bankrupt the economy eventually. To add to this notion is the ageing population. The problem with this argument is that it assumes such things as the the older you get the more time you spend on hospitals beds which is not the case according to research. Furthermore, many private hospitals and insurances do not have facilities for older members of the community. Economic participation of the ageing population must instead be recognised and appreciated.
2. Present a case study of a client who is affected by this issue (can use case studies in this manual)
CURRENT PHILOSOPHIES
Identify three principles which support the current philosophies.
Give examples of how they impact on aged care services.
Refer to Learning Resources - The Vision For Community Care, Principles, What Choices Are Available To Older People And Carers In 2007?
1.
2.
3.
DEMOGRAPHICS OF AGEING
1. How has aged care funding changed in the past 5 years, give two examples? What has been the impact on the HACC Program?
In the past 5 years, aged care funding has focused on training qualified practicioners for example,
1.Employer sponsored training places
2.Scholarships for students
The Impact on HACC program is that it is more industry relevant because employers are involved.
2. How has local/regional demographics impacted/changed service delivery in your workplace?
Because of an ageing population service delivery has been negatively impacted because of limited skills personnel.
3. How have these changes in demographics impacted on your day by day work?
Longer working hours and increased emotional strain
IMPACT OF LEGISLATION
Consider your workplace policies and procedures/consult your supervisor. Organisations must comply with the laws of the land. Choose two examples of a policy/procedure which ensure compliance with legislation.
How do these two policies/procedures impact on your work?
1.Policy ;Health services must be available to all clients and free from any form of discrimination related to a person’s country of birth, language, culture, race or religion.
When providing health care, it is given to all without prejudice in the worklplace
2 All clients shall receive fair treatment.
Clients in the workplace have a care plan that is customised to their needs.
IMAGES OF AGEING
Referring to the Learning Resource: Images of Ageing
1. What is a myth about aged people?
• How does this myth impact on their lives?
2. What is a stereotype of aged people?
• How does this stereotype impact on their lives?
3. What is an assumption of aged people?
• How does this assumption impact on their lives?
INDIVIDUALITY OF AGEING
What are three choices that impact on the ageing process for individuals?
How do they impact? eg on the physical body, the psychological health
1. Physical Activity & Diet
2. Emotional Integrity
3. Spiritual harmony
Physical activity keeps the body fit and strong and hence slow down ageing. People with emotional burden or depression and who are not spiritually at peace accelerate their ageing.
RIGHTS AND RESPONSIBILITIES
Attach client information that details client rights and responsibilities, including the process for compliments and complaints.
1. How is this information distributed and explained to clients?
When clients sign up, the complaint policy is made available to them to read and ask questions if there are any. This ensures that they know the available routs they can take should they have complaints and for them to also know their rights.
2. Use a case study to describe the process for client complaints.
If a client has a complaint, they call a customer relations coordinator who reports directly to the general manager on a toll free number. If their complaint is not satisfactorily resolved, they can contact the Community Services Commission or Disability Complaints Service whose numbers the client is provided with.
ACCESS AND EQUITY
1. How does your workplace demonstrate a commitment to access and equity for clients?
It is policy that health services will be provided free from all forms of discrimination and that health care will be developed and delivered on the basis of fair treatment.
2. How does this impact on your work? Present a case study of a diverse client.
Mrs Ho is originaly from Hong Kong and does not speak English very well. Consequently, she has an interpreter and as part of her activities, Hong Kong celebration days are celebrated by her care workers.
PARTICIPATION
1. How do clients participate in decision making about the service?
Through advocating for their preferences and interest in the development of a care plan. 2. How do you encourage this?
By asking clients to voice their opinion regarding service delivery.
Element 1:
Demonstrate an understanding of the structure and profile of the aged care sector.
The aged care sector has policies and legislature that are aimed at protecting clients. It encourages client participation in drawing up a care plan or during interation with care worker.
Element 2:
Demonstrate a commitment to the philosophy of ‘positive ageing’
Funding to the tune $1.4 million dollars by the office of Senior Victorians to support the positive ageing project which aims to build the capacity of local government to plan for an ageing population. It also aims to provide leadership in promoting "age friendly" communities that create opportunities for senior Victorians to live active and fulfilling lives.
Element 3:
Support the rights and interests of older person
KEY ISSUES
1. Attach/describe a news item from television, radio, newspaper or magazine relating to older people.
The age-old quandary
The age-old quandary
By Karen Kissane
April 20 2002
You are 75. You break a hip in a fall and need surgery. While in hospital, you pick up a post-operative wound infection and develop pneumonia. Your forgetfulness intensifies into more serious dementia symptoms as you struggle to cope with the twin assaults of illness and a strange environment. You are now frail and will need weeks or months of care and rehabilitation; perhaps you will never go home again.
The hospital is not set up for convalescents and wants your bed for more urgent patients. Who will look after you, and how will it be paid for?
It is the kind of question that is central not just to your future but to Australia's, according to Treasurer Peter Costello. This week he warned cabinet of a $50 billion-a-year budget blow-out in health, aged care and income-support programs within a generation unless the sharply rising costs of a greying population are curbed. A visionary attempt to grapple with the future - or an attempt to soften up the public for cuts to Medicare and social welfare?
"This analysis is scaremongering designed to frighten people into accepting public sector budget cuts when, in reality, they are probably not going to be required," says Stephen Duckett, professor of health policy at La Trobe University.
But an administrator in a private hospital disagrees about the need for concern about the community's ability to pay for the needs of older people. "Future horror scenario?" she says. "The system has trouble coping with the elderly now."
In the next 40 years, the number of Australians aged over 65 will rise from 2.4 million to 6.2 million, with the proportion of older people doubling from 12 to 25 per cent. Towards the middle of next century, after the baby boomers have retired, there might be only 2.5 people of working age for every person over 65, compared to more than five people currently.
According to a report by Access Economics to the Federal Government, the number of workers and the level of income tax revenue is predicted to slow down from now; pension outlays will increase from 2010; health spending will rise from 2020; and aged-care demands will increase from 2030.
The figures sound daunting, and some researchers are warning about the necessity to budget for the needs of the elderly. Other analysts, however, say the outcome is unlikely to be dire, with many comparable countries already coping well with higher levels of older people. "Australia in 20 or 30 years' time is going to be like France is now," Duckett says. "We will be older, but we will be roughly the same as several European countries are now. These European countries aren't bankrupt, so what makes us think that we're going to be bankrupt?"
The current banner of the doom-and-gloom brigade is a landmark report due to be released by the government with next month's federal budget. The Inter-generational Report by Treasury's Retirement Incomes Modelling Unit is the first official government study of the future cost of current policies, and it predicts that advances in medical science that allow people to live longer will place a massive burden on taxpayers, mostly due to expensive new drugs and medical technology. The report is designed to trigger a public debate on the sustainability of existing health and aged-care programs.
News of the report came as the Myer Foundation announced a million-dollar project to develop a vision for aged care in Australia, and as the United Nations ended its world assembly on ageing in Madrid.
Greying is a global issue, says Professor Gary Andrews, of Adelaide's Centre for Ageing Studies, who attended the assembly. He says developed nations face a significant increase in the very old (those aged 80-90), but ageing is also relevant to the developing world. "Already in a country like China you have more than 100 million people aged 60 and over," he says.
While the details of the Treasury report are still under wraps, others have previously tried to estimate what ageing will cost Australia. Aged-care spending will more than double in real terms from 1997 to 2031, from $5.8 billion to $14.3 billion, warned a staff research paper by the Productivity Commission in October, 2000. But Australia will probably be richer and more able to afford it; even with relatively conservative estimates of gross domestic product, the report said, "spending grows by only about 25 per cent when expressed as a share of GDP".
The report, Long-Term Aged Care: Expenditure Trends and Projections, predicted that nursing home beds would need to increase from 78,600 to 158,500 in 2031. But, while the aged's health costs would rise in real terms each year to 2031, they would fall, relative to GDP, until 2021; by 2031, they will be 2.9 per cent of GDP.
Several health economists claim that the view of the elderly as a drain on health resources is wrong. Duckett has researched whether age is a factor in the cost of hospital stays, examining whether 70-year-olds cost more than 55-year-olds with the same condition. He found no systematic variation. "People think they should worry because older people stay longer, but in reality they often have substantially less investigation and interventions than younger people," he says.
Andrews agrees: "The fact that more people are in their 70s and 80s and 90s has a relatively small impact on total health costs. A lot of research in the past decade (confirms) less than 5 per cent of the increase in health care costs is accounted for by the population ageing."
Professor Jeff Richardson, of the Centre for Health Program Evaluation at Monash University, says it is not ageing itself that is the problem: "It's ageing plus new technology."
But another question raised by the Treasury report is acknowledged by many analysts as a problem: the ever-rising cost of drugs. John Goss, principal economist with the Australian Institute of Health and Welfare in Sydney, says: "The growth for the Pharmaceutical Benefits Scheme has been 9 per cent per year in real terms. If you have growth of 9 per cent, the doubling period is about eight years. It quadruples in 16 years, and it's eight times (higher) in 24 years. It has huge momentum."
An unknown factor in the future equation is the health status of the next generation of oldies. Does living longer just mean more years of disability and degeneration, or will increased life expectancy also mean more years of good health?
Duckett believes the latter. "The reason people are living longer is that they are healthier in old age. An 80-year-old in 20 years' time will be healthier than an 80-year-old today."
And it has always been the case that people usually chew up the largest amount of health care in the two years before they die, whether this is at 65 or 85, because that is when their health breaks down. "The general view across demographers and health planners is that the need for health care is not based on years from birth but rather is based on years to death," Duckett says.
There is another, gloomier possibility. People who live longer because of a reduction in one disease might contract another that disables them; if you avoid the coronary at 70, will you face dementia at 72? The Productivity Commission report says advances such as artificial joint replacements and improved treatments for osteoporosis, arthritis and dementia might lessen disability among the aged. But technology might also increase the survival time of people with disabilities, the report says. "Dialysis for renal failure increases survival time, but the aged person receiving such treatment will still typically be unable to perform many tasks unaided."
Then again, disability does not necessarily mean institutionalisation. The Productivity Commission estimates that, while about 18 per cent of those over 65 have a profound or severe disability, only 3 per cent of old people are in residential care.
For some people trying to care for the aged now, the question of whether the future poses problems is nonsensical. There is already a national shortage of nursing home and hostel beds, long delays for elective surgery and cancer treatments, and problems with elderly patients acting as "bedblockers" in acute hospitals (too sick to go home, but with nowhere else to go).
"An acute hospital is not a convalescent home for looking after elderly people when they are not acutely ill," says Denis Hogg, chief executive of Epworth Hospital. "But where do you refer them to for their on-going care?"
He denies that private hospitals cherry-pick to avoid bedblocking - "In our emergency department, 75 per cent of people admitted are over 75" - and he says Epworth has had to set up its own self-funded aged-care coordination team to try to find places for older people who need care following discharge.
"Step-down" care, between a hospital visit and home, is unfunded by private insurance and often unavailable, says Angela Magarry, director of policy for Catholic Health Australia. Like many other organisations, CHA wants aged care and health to be run by one level of government to prevent buckpassing of responsibilities and gaps in the system. CHA has also called for a Medicare "grey card" to be established to protect older people's right to care.
Denys Correll, national executive director of the Council on the Ageing, agrees that Medicare should be strengthened and says problems such as the blowout in pharmaceutical costs can be managed by price volume agreements between the government and manufacturers.
Goss points out that anxiety over costs tends to ignore benefits: "There's no need for doom and gloom if any increase in expenditure produces more benefits than costs in terms of older people being healthier, suffering less pain and having a lower chance of dying."
An extraordinary number of older people are involved in the informal economy through their care of grandchildren, he points out.
"There's often strong interests behind the position saying that 'the world is falling apart'," says John McCallum, professor of public health at the University of Western Sydney. He is concerned that an atmosphere of pessimism might encourage the belief that more health and aged-care services must be privatised if the government is not to go bust. In his view, "there are serious issues and they do have to be dealt with, but they're not necessarily going to break the bank or destroy the Australian way of life".
Karen Kissane is an Age senior writer.
This story was found at: http://www.theage.com.au/articles/2002/04/19/1019020708222.html
What issue is the focus of the item?
There is a general belief that older people are expensive to maintain and that as a result, they will bankrupt the economy eventually. To add to this notion is the ageing population. The problem with this argument is that it assumes such things as the the older you get the more time you spend on hospitals beds which is not the case according to research. Furthermore, many private hospitals and insurances do not have facilities for older members of the community. Economic participation of the ageing population must instead be recognised and appreciated.
2. Present a case study of a client who is affected by this issue (can use case studies in this manual)
CURRENT PHILOSOPHIES
Identify three principles which support the current philosophies.
Give examples of how they impact on aged care services.
Refer to Learning Resources - The Vision For Community Care, Principles, What Choices Are Available To Older People And Carers In 2007?
1.
2.
3.
DEMOGRAPHICS OF AGEING
1. How has aged care funding changed in the past 5 years, give two examples? What has been the impact on the HACC Program?
In the past 5 years, aged care funding has focused on training qualified practicioners for example,
1.Employer sponsored training places
2.Scholarships for students
The Impact on HACC program is that it is more industry relevant because employers are involved.
2. How has local/regional demographics impacted/changed service delivery in your workplace?
Because of an ageing population service delivery has been negatively impacted because of limited skills personnel.
3. How have these changes in demographics impacted on your day by day work?
Longer working hours and increased emotional strain
IMPACT OF LEGISLATION
Consider your workplace policies and procedures/consult your supervisor. Organisations must comply with the laws of the land. Choose two examples of a policy/procedure which ensure compliance with legislation.
How do these two policies/procedures impact on your work?
1.Policy ;Health services must be available to all clients and free from any form of discrimination related to a person’s country of birth, language, culture, race or religion.
When providing health care, it is given to all without prejudice in the worklplace
2 All clients shall receive fair treatment.
Clients in the workplace have a care plan that is customised to their needs.
IMAGES OF AGEING
Referring to the Learning Resource: Images of Ageing
1. What is a myth about aged people?
• How does this myth impact on their lives?
2. What is a stereotype of aged people?
• How does this stereotype impact on their lives?
3. What is an assumption of aged people?
• How does this assumption impact on their lives?
INDIVIDUALITY OF AGEING
What are three choices that impact on the ageing process for individuals?
How do they impact? eg on the physical body, the psychological health
1. Physical Activity & Diet
2. Emotional Integrity
3. Spiritual harmony
Physical activity keeps the body fit and strong and hence slow down ageing. People with emotional burden or depression and who are not spiritually at peace accelerate their ageing.
RIGHTS AND RESPONSIBILITIES
Attach client information that details client rights and responsibilities, including the process for compliments and complaints.
1. How is this information distributed and explained to clients?
When clients sign up, the complaint policy is made available to them to read and ask questions if there are any. This ensures that they know the available routs they can take should they have complaints and for them to also know their rights.
2. Use a case study to describe the process for client complaints.
If a client has a complaint, they call a customer relations coordinator who reports directly to the general manager on a toll free number. If their complaint is not satisfactorily resolved, they can contact the Community Services Commission or Disability Complaints Service whose numbers the client is provided with.
ACCESS AND EQUITY
1. How does your workplace demonstrate a commitment to access and equity for clients?
It is policy that health services will be provided free from all forms of discrimination and that health care will be developed and delivered on the basis of fair treatment.
2. How does this impact on your work? Present a case study of a diverse client.
Mrs Ho is originaly from Hong Kong and does not speak English very well. Consequently, she has an interpreter and as part of her activities, Hong Kong celebration days are celebrated by her care workers.
PARTICIPATION
1. How do clients participate in decision making about the service?
Through advocating for their preferences and interest in the development of a care plan. 2. How do you encourage this?
By asking clients to voice their opinion regarding service delivery.
CHCAC6C Support Older Person To Meet Their Emotional And Psychological Needs - Tasks
Tasks:
Element 1
Support the older person remain engaged with their social network and the wider community
What are support networks for older people?
Support networks for older people can be family and friends who help to support them.
What are community networks?
Community networks are public social networks such as dinner club which an older person may attend.
What other types of networks are available to assist the older people?
Proffesional service networks are companies that render service to older people to assist in their day to day lifes. These include nursing homes.
Element 2
Support the older person to meet their emotional and psychological needs
What does Psychosocial mean?
Involving aspects of social and psychological behavior
What types of fears face older people?
Loss of privacy, feelings of inadequacy to support oneself, inability to interact with the rest of the community
Think of a change that might happen to an older person as part of the ageing process. It can be a physical, cognitive, social or emotional change. Think about your own work role and responsibilities. Think about the policies and procedures that might apply in the workplace.
Explain the following:
· The details of the change
An increased level of anxiety in the patient. Patient is always uneasy and appears uncertain about many things
· How this change might affect their activities of daily living
Loss of self esteem and inability to communicate effectively what they want or prefer which might lead to frustration and withdrawal.
· How you would talk to the older person and/or their advocate about the change
I would communicate with them in a way that conveys that they are worthwhile , unique and valuable. This would involve positive attention, active listening , and being courteous.
· How you would help the person manage the change in the most positive way
The older person can be helped in managing the situation by developing positive relationship of trust and showing them that it is normal to be anxious. Furthermore, the older person should be affirmed positively and all positive change be complimented. I would remain empathetic and share related or similar experiences.
· Any risks which might be a part of the change
Anxiety can lead to self neglect
· How you would help the older person manage the risk
Ensure that from a hygeine aspect they are looked after and involve them more and more in making decisions about their hygeine.
· Any information you would need to write down or share with others about the change
I would share with a registered nurses the changes in behaviour and try to identify the possible social, spritual or physical triggers of anxiety and assess what might need to go into the care plan.
Element 3
Recognise and accommodate the older person’s cultural and spiritual preferences
1. What impact does cultural diversity have on aged care in Australia?
Aged care has had to change with the diversity in Australian culture. This means that care providers need to establish culturally relevant aged care.
2. Re-write Australia’s multicultural policy in brief.
The diverse cultural, linguistic and spiritual requirements of resident and clients will be acknowledged and addressed throughout all care provision
Element 4
Support the older person who is experiencing loss and grief
1. What is grief and loss?
Grief is the process of reacting to a loss. The loss may be physical (such as a death), social (such as divorce), or occupational (such as a job). Emotional reactions of grief can include anger, guilt, anxiety, sadness, and despair. Physical reactions of grief can include sleeping problems, changes in appetite, physical problems, or illness.
2. What types of losses could our client be going through?
Physical, social or occupational loss
3. What are the various stages of grief and loss?
· Denial
· Bargaining
· Depression
· Anger
· Acceptance
4. What are some signs that an older person is experiencing grief and what do you do when you notice them?
Physically, persons affected by grief may experience:
- Fatigue and exhaustion alternating with periods of high alertness and energy
- Temporary hearing loss or vision impairment (possibly associated with dissociation)
-Difficulty sleeping
-Disturbed appetite (either more appetite or less appetite than normal)
-Muscle tremors
-Chills and/or sweating
-Difficulty breathing or rapid respiration
-Increased heart rate or blood pressure
-Stomach and/or intestinal problems
-Nausea and/or dizziness
5. What are some of the support services that a person experiencing loss or grief can be referred to?
A person experiencing grief may be referred to a psychologist, counselors or family and friends.
Element 5.
Recognise and accommodate the older person’s expressions of identity and sexuality
1. What are some Spiritual needs of older people?
Older people may need to be taken to a place of worship such as church or synagogue or shrine.
2. What are some cultural needs of older people?
Older people may need to be communicated with in a culture specific way, greeted in a particular or dressed in a particular way
3. What may be some Sexuality and identity needs of older people?
Older people may want sex workers or to masturbate. The may need to feel sexually attractive.
Element 1
Support the older person remain engaged with their social network and the wider community
What are support networks for older people?
Support networks for older people can be family and friends who help to support them.
What are community networks?
Community networks are public social networks such as dinner club which an older person may attend.
What other types of networks are available to assist the older people?
Proffesional service networks are companies that render service to older people to assist in their day to day lifes. These include nursing homes.
Element 2
Support the older person to meet their emotional and psychological needs
What does Psychosocial mean?
Involving aspects of social and psychological behavior
What types of fears face older people?
Loss of privacy, feelings of inadequacy to support oneself, inability to interact with the rest of the community
Think of a change that might happen to an older person as part of the ageing process. It can be a physical, cognitive, social or emotional change. Think about your own work role and responsibilities. Think about the policies and procedures that might apply in the workplace.
Explain the following:
· The details of the change
An increased level of anxiety in the patient. Patient is always uneasy and appears uncertain about many things
· How this change might affect their activities of daily living
Loss of self esteem and inability to communicate effectively what they want or prefer which might lead to frustration and withdrawal.
· How you would talk to the older person and/or their advocate about the change
I would communicate with them in a way that conveys that they are worthwhile , unique and valuable. This would involve positive attention, active listening , and being courteous.
· How you would help the person manage the change in the most positive way
The older person can be helped in managing the situation by developing positive relationship of trust and showing them that it is normal to be anxious. Furthermore, the older person should be affirmed positively and all positive change be complimented. I would remain empathetic and share related or similar experiences.
· Any risks which might be a part of the change
Anxiety can lead to self neglect
· How you would help the older person manage the risk
Ensure that from a hygeine aspect they are looked after and involve them more and more in making decisions about their hygeine.
· Any information you would need to write down or share with others about the change
I would share with a registered nurses the changes in behaviour and try to identify the possible social, spritual or physical triggers of anxiety and assess what might need to go into the care plan.
Element 3
Recognise and accommodate the older person’s cultural and spiritual preferences
1. What impact does cultural diversity have on aged care in Australia?
Aged care has had to change with the diversity in Australian culture. This means that care providers need to establish culturally relevant aged care.
2. Re-write Australia’s multicultural policy in brief.
The diverse cultural, linguistic and spiritual requirements of resident and clients will be acknowledged and addressed throughout all care provision
Element 4
Support the older person who is experiencing loss and grief
1. What is grief and loss?
Grief is the process of reacting to a loss. The loss may be physical (such as a death), social (such as divorce), or occupational (such as a job). Emotional reactions of grief can include anger, guilt, anxiety, sadness, and despair. Physical reactions of grief can include sleeping problems, changes in appetite, physical problems, or illness.
2. What types of losses could our client be going through?
Physical, social or occupational loss
3. What are the various stages of grief and loss?
· Denial
· Bargaining
· Depression
· Anger
· Acceptance
4. What are some signs that an older person is experiencing grief and what do you do when you notice them?
Physically, persons affected by grief may experience:
- Fatigue and exhaustion alternating with periods of high alertness and energy
- Temporary hearing loss or vision impairment (possibly associated with dissociation)
-Difficulty sleeping
-Disturbed appetite (either more appetite or less appetite than normal)
-Muscle tremors
-Chills and/or sweating
-Difficulty breathing or rapid respiration
-Increased heart rate or blood pressure
-Stomach and/or intestinal problems
-Nausea and/or dizziness
5. What are some of the support services that a person experiencing loss or grief can be referred to?
A person experiencing grief may be referred to a psychologist, counselors or family and friends.
Element 5.
Recognise and accommodate the older person’s expressions of identity and sexuality
1. What are some Spiritual needs of older people?
Older people may need to be taken to a place of worship such as church or synagogue or shrine.
2. What are some cultural needs of older people?
Older people may need to be communicated with in a culture specific way, greeted in a particular or dressed in a particular way
3. What may be some Sexuality and identity needs of older people?
Older people may want sex workers or to masturbate. The may need to feel sexually attractive.
CHCAC15A Provide Care Support assessment 1 and answers
Tasks:
Element 1:
Use communication strategies which take account of the progressive and variable nature of dementia
What are the early signs of dementia?
Lapse in memory
Difficulty in making decisions and judgement
Difficulty in following conversations
Difficulty in doing calculations
Difficulty in following directions
Why have assessments?
To establish the cause and potentially
-treat, improve or reverse condition.
What are some common signs of dementia?
Perseveration (ie repetition) of words, phrases or actions
Perseveration of thought could be called the 'stuck needle syndrome', as the person gets stuck with a subject, and is unable to move from it
Inability to deal with abstract thought: for example, a person will find it hard to grasp the meaning of sayings such as "A rolling stone gathers no moss', their explanation being quite literal
Difficulty in understanding others' viewpoints
Inability to put events or actions into a logical order
Impulsivity, poor judgement, mood swings
Inability to learn from experience
Difficulty in monitoring own behaviour
Name five problems associated with ageing.
Disorientation,
poor concentration,
self neglect Occurs rapidly, worse at night;
disappears after underlying cause treated;
clouding of consciousness
What are the differences between depression and dementia?
A person with depression displays signs of slowness, non responsiveness and normally gives accurate answers where as a person with dimensia has memory lapses, difficulties in following direction, judgenement and decision making,
What is reality orientation?
Reality orientation is essentially a means of helping people to remember, hold onto their skills, abilities and experiences, to relearn some skills, express their personalities and enjoy their lives as much as possible.
What are possible errors of using reality orientation?
Interferring rather than supporting by not reasonably giving patient control
Deprivation of normal routine
Forgetting to employ touch, eye contact and explanation which can impair communication
Humiliating and odd behaviour by 'supporters' is damaging; eg. a barber who shaves an elderly man without first consulting him about how or whether it should be done is hardly reality-oriented!
What is reminiscence?
Recalling a patient’s past events and or experiences in conversation
How do you gain cooperation and provide reassurance to clients by routinely using reality orientation?
Reality orientation gives a carer a better understanding of the patient which helps in promoting positive staff attitudes. Furthermore, it helps patients to remain in touch with the here and now which enables reasonable independence.
How do you use families as resource to assist in developing appropriate activities?
by accessing information about client reminiscences and routines and provide training for them to assist them to understand the disease, its impact on the person and some approaches to providing care
Discuss three Behaviors of concern that a person with Dementia may exhibit
A person with dementia may become more withdrawn, forgetful and neglect their own personal hygiene.
Name 5 (five) Difficult or challenging behaviour associated with dementia and how do you deal with these behaviours?
Hostility
· Inform doctor or community psychiatric nurse to assess possible cause
· Get psychology assessment
· Remain calm but firm
Hallucination
· Arrange a physical examination
· Get psychology assessment
Difficulty in performing self help activites
· Behaviours are observed and documented to determine triggers which may be related
· Get Psychological assessment
Dressing
Careful prompting or reminders may help the person get dressed independently
Set out the clothes in a pile with the first item to be put on at the top
Try using the task breakdown technique. This involves breaking the task into simple,manageable steps and doing them one step at a time. You may have to gently remind the person with each step, or do several of the steps yourself. Reassurance and praise for each successful step will make the task more pleasurable for both of you
Inability to Communicate
· Use simple words
· Watch for non-verbal clues
Name 4 (four) Signs that a person with Dementia is confused or distressed
Pulling of clothes e.g lifting of skirt
Withdrawal
They keep saying I dont know
Slow to respond
What is challenging behaviour?
Behaviour that needs to be closely monitored and that has possible detrimental consequences
How do you document observed behaviors of a demented person?
Use a behaviour chart to document behaviours. Behaviours are observed and documented to determine triggers which may be related with regards to ;physical and emotional health, environmental,tasks,communication.
Element 1:
Use communication strategies which take account of the progressive and variable nature of dementia
What are the early signs of dementia?
Lapse in memory
Difficulty in making decisions and judgement
Difficulty in following conversations
Difficulty in doing calculations
Difficulty in following directions
Why have assessments?
To establish the cause and potentially
-treat, improve or reverse condition.
What are some common signs of dementia?
Perseveration (ie repetition) of words, phrases or actions
Perseveration of thought could be called the 'stuck needle syndrome', as the person gets stuck with a subject, and is unable to move from it
Inability to deal with abstract thought: for example, a person will find it hard to grasp the meaning of sayings such as "A rolling stone gathers no moss', their explanation being quite literal
Difficulty in understanding others' viewpoints
Inability to put events or actions into a logical order
Impulsivity, poor judgement, mood swings
Inability to learn from experience
Difficulty in monitoring own behaviour
Name five problems associated with ageing.
Disorientation,
poor concentration,
self neglect Occurs rapidly, worse at night;
disappears after underlying cause treated;
clouding of consciousness
What are the differences between depression and dementia?
A person with depression displays signs of slowness, non responsiveness and normally gives accurate answers where as a person with dimensia has memory lapses, difficulties in following direction, judgenement and decision making,
What is reality orientation?
Reality orientation is essentially a means of helping people to remember, hold onto their skills, abilities and experiences, to relearn some skills, express their personalities and enjoy their lives as much as possible.
What are possible errors of using reality orientation?
Interferring rather than supporting by not reasonably giving patient control
Deprivation of normal routine
Forgetting to employ touch, eye contact and explanation which can impair communication
Humiliating and odd behaviour by 'supporters' is damaging; eg. a barber who shaves an elderly man without first consulting him about how or whether it should be done is hardly reality-oriented!
What is reminiscence?
Recalling a patient’s past events and or experiences in conversation
How do you gain cooperation and provide reassurance to clients by routinely using reality orientation?
Reality orientation gives a carer a better understanding of the patient which helps in promoting positive staff attitudes. Furthermore, it helps patients to remain in touch with the here and now which enables reasonable independence.
How do you use families as resource to assist in developing appropriate activities?
by accessing information about client reminiscences and routines and provide training for them to assist them to understand the disease, its impact on the person and some approaches to providing care
Discuss three Behaviors of concern that a person with Dementia may exhibit
A person with dementia may become more withdrawn, forgetful and neglect their own personal hygiene.
Name 5 (five) Difficult or challenging behaviour associated with dementia and how do you deal with these behaviours?
Hostility
· Inform doctor or community psychiatric nurse to assess possible cause
· Get psychology assessment
· Remain calm but firm
Hallucination
· Arrange a physical examination
· Get psychology assessment
Difficulty in performing self help activites
· Behaviours are observed and documented to determine triggers which may be related
· Get Psychological assessment
Dressing
Careful prompting or reminders may help the person get dressed independently
Set out the clothes in a pile with the first item to be put on at the top
Try using the task breakdown technique. This involves breaking the task into simple,manageable steps and doing them one step at a time. You may have to gently remind the person with each step, or do several of the steps yourself. Reassurance and praise for each successful step will make the task more pleasurable for both of you
Inability to Communicate
· Use simple words
· Watch for non-verbal clues
Name 4 (four) Signs that a person with Dementia is confused or distressed
Pulling of clothes e.g lifting of skirt
Withdrawal
They keep saying I dont know
Slow to respond
What is challenging behaviour?
Behaviour that needs to be closely monitored and that has possible detrimental consequences
How do you document observed behaviors of a demented person?
Use a behaviour chart to document behaviours. Behaviours are observed and documented to determine triggers which may be related with regards to ;physical and emotional health, environmental,tasks,communication.
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