Principles, standards & competencies for attendant care

Good attendant care

At essence good attendant care is supporting people to be independent in:

  • Understanding and communicating
  • Mobility
  • Self-care
  • Getting along and interacting with other people
  • Life activities like leisure, work and education and
  • Participation in the community.

The attendant care required will be unique to each individual and goal directed.

Good attendant care:

  • Is based on principles
  • Meets standards
  • Is provided by competent staff
  • Is supported by professional service providers (or the person receiving attendant care and/or their family if they are the employer).

To get attendant care right the client (and their family) must be fully participating in the process.

The client, their family, workers and service providers all need to know what good attendant care looks like and how to get it.

The quality of the working relationships need to be such that everyone involved:

  • Feels safe, respected and heard
  • Can talk about relevant issues and concerns (everything from the best way to do a lift or transfer to personal and cultural preferences about food, ways of communicating and values and beliefs and concerns and complaints).

Principles

Good attendant care is:

Person centred

Where the person is at the centre of planning and delivery of services

Enabling life in and with community

Sees the person as part of a social network which may include family, friends, neighbourhood & community

Goal directed (to maximise independence)

During rehabilitation – improvement focussed to achieve new goals
Life going on – to maintain goals (and prevent deterioration)

Based on human rights

For example respect for the dignity and independence of persons, non-discrimination, full and effective participation and inclusion in society.

Based on quality management principles

For example focussing on outcomes for people who use services, making evidence based decisions and encouraging continuous improvement.

Standards

These principles are supported by standards.

National Standards for Disability Services

In Australia, Attendant Care services are required to meet the National Standards for Disability Services.

The Attendant Care Industry Standard

The peak body for Attendant Care Services, the Attendant Care Industry Association also has a set of standards its members adopt: the Attendant Care Industry Standard.  In NSW these standards are also recognised by the Lifetime Care Authority and Ageing Disability and Home Care (ADHC) as standards service providers should meet.

Competencies

One key ingredient in meeting the standards is having competent attendant carers.

Competency Frameworks for Attendant Care Workers

In NSW the Life Time Care Authority and ADHC have collaborated with service providers to  develop  competency standards for attendant care workers working with acquired brain injury (ABI) and spinal cord injury (SCI): Competency Frameworks for Attendant Care Workers

What good attendant care looks like

These principles, standards and competencies provide the foundations for “what good attendant care looks like” as it is described in this web site.

 

Principles

Good attendant care is:

  • Person centred &
  • Enabling life in and with community
  • Goal directed (to maximise independence)
  • Based on human rights
  • Based on quality management principles
Person centred & enabling life in the community

Person centred & enabling life in the community

The National Disability Standards reflect the move towards person-centred approaches whereby people with disability are at the centre of planning and delivery.

The intention of person-centred approaches is to maximise, as much as reasonably possible, the capacity for people with disabilities to take control of their lives.

Person-centred approaches ensure that individuals are in the centre of service design, planning, delivery and review. Individuals shape and direct service and support arrangements to suit their strengths, needs and goals with the support of families, friends, carers and advocates.

A person centred approach puts clients and their families at the heart of all decisions. It aims to:

  • Be client focused,
  • Promote independence and autonomy,
  • Provide choice and control and
  • Be based on a philosophy of collaboration and teamwork.
  • It takes into account the clients’ needs and views and builds relationships with family members.

A person centred approach gives people:

  • valued roles
  • participation and belonging in the community
  • freely given relationships
  • greater authority over decisions about the way they live
  • genuine partnership between the service, themselves and/or their family and allies
  • individualised and personalised support arrangements.
Goal directed (to maximise independence)

Goals

Goals are what the client wants to achieve.
Goals belong to the client, not to workers, clinicians or service providers. 

Rehabilitation programs exist so that clients can achieve their goals.  Rehabilitation goals typically focus on improvement.

Clients have life goals after rehabilitation – including maintain goals and prevent deterioration.

Attendant care, when required, is part of achieving clients’ goals.

Benefits of setting goals

Setting client goals:

  • Helps clients motivate themselves – i.e. it is easier to work towards achieving your goals when those goals are explicit and you are clear about what you are wanting to achieve.
  • Makes it clear to everyone what the client is wanting to achieve
  • Makes it easier for everyone working with the client to work together as a team and coordinate their efforts to achieving the goals.
  • Makes it easier for everyone to see how well things are working: Are the goals being achieved?
The human rights principles

Human rights principles

Australia has agreed to uphold human rights set out in a number of international treaties and declarations, including the Convention on the Rights of Persons with Disabilities.

The National Disability Standards draw on these and in particular the principles within the Convention on Rights of Persons with Disabilities, which was developed by the United Nations.
An additional principle has been added to strengthen the focus on partnerships, consistent with the National Disability Strategy. This emphasises the importance of people with disability participating in decisions that affect their lives along with family, friends, carers and advocates. The National Disability Strategy promotes active participation in decision making to safeguard and advance the human rights, wellbeing and interests of people with disability.

The human rights principles are:

  • respect for the inherent dignity, independence of persons and individual autonomy, including the freedom to make one's own choices;
  • non-discrimination;
  • full and effective participation and inclusion in society;
  • respect for difference and acceptance of persons with disabilities as part of human diversity and humanity;
  • equality of opportunity;
  • accessibility;
  • equality between men and women;
  • respect for the evolving capacities of children with disability and respect for the right of children with disability to preserve their identities; and
  • active partnerships between services and people with disability, and where appropriate, their families, friends, carers and/or advocates.
The quality management principles

Quality management principles

These principles describe core features of a service focused on quality for people with disability. The principles emphasise the involvement of people with disability, as well as family, friends, carers and advocates in monitoring and reviewing services and supports.

They also emphasise taking a long-term view of how the service or support contributes to the person’s life.

The Quality Management principles (that should underpin the way the service provider works) are:

  • focus on outcomes for people who use services and supports;
  • provide leadership;
  • involve individuals and staff;
  • use a process approach;
  • take a systems approach;
  • encourage continuous improvement;
  • make evidence-informed decisions; and
  • engage in collaborative partnerships.

 

Disability service standards

There are six National Standards that apply to disability service providers.

The full text of each of the six standards is below:

1. Rights:

The service promotes individual rights to freedom of expression, self-determination and decision-making and actively prevents abuse, harm, neglect and violence.

Introduction

The intent of this standard is to promote ethical, respectful and safe service delivery which meets, if not exceeds, legislative requirements and achieves positive outcomes for people with disability. The Human Rights principles are relevant across all the standards and each standard supports the achievement of basic rights. This standard has a focus on particular rights such as self-determination, choice, privacy and freedom from discrimination.

The standard recognises people’s inherent right to freedom of expression and the right to make decisions about and exercise control over their own lives. It reinforces the fundamental right of people with disability to have respect and dignity. This includes the dignity of risk - the right to choose to take some risks in life.

The standard acknowledges the risks of harm, neglect, abuse or violence which some people with disability may face when using services or supports. The standard highlights the roles for services and supports, families, friends, carers and advocates in reducing these risks. The standard promotes individual rights and individual and service responsibility.

The standard emphasises the importance of:

  • dignity and respect;
  • freedom of expression;
  • self-determination;
  • choice and control;
  • confidentiality and privacy;
  • freedom from discrimination, exploitation, abuse, harm, neglect and violence;
  • the role of families, friends, carers and advocates in the safeguarding of rights; and
  • comprehensive systems to prevent or promptly respond to any breaches of rights.

Rights for people

I have the right to exercise control and choice when I use services or supports. I also have the right to dignity of risk and to be free from discrimination or harm.

Outcomes for people

I can make choices about the services and supports I use, and how I use them. When I use a service or support, I am respected and safe

Standard for service

The service promotes individual rights to freedom of expression, self-determination and decision-making and actively prevents abuse, harm, neglect and violence.

Indicators of Practice

1:1 The service, its staff and its volunteers treat individuals with dignity and respect.

1:2 The service, its staff and its volunteers recognise and promote individual freedom of expression.

1:3 The service supports active decision-making and individual choice including the timely provision of information in appropriate formats to support individuals, families, friends and carers to make informed decisions and understand their rights and responsibilities.

1:4 The service provides support strategies that are based on the minimal restrictive options and are contemporary, evidence-based, transparent and capable of review.

1:5 The service has preventative measures in place to ensure that individuals are free from discrimination, exploitation, abuse, harm, neglect and violence.

1:6 The service addresses any breach of rights promptly and systemically to ensure opportunities for improvement are captured.

1:7 The service supports individuals with information and, if needed, access to legal advice and/or advocacy.

1:8 The service recognises the role of families, friends, carers and advocates in safeguarding and upholding the rights of people with disability.

1:9 The service keeps personal information confidential and private.

2. Participation and Inclusion:

The service works with individuals and families, friends and carers to promote opportunities for meaningful participation and active inclusion in society.

Introduction

The intent of this standard is to promote the connection of people with disability with their families, friends and chosen communities. It also requires that services work together with individuals to enable their genuine participation and inclusion.

This standard recognises the role that services can play in enabling the contribution and inclusion of people with disability and their valued participation in the community including work and learning. In meeting this standard, services will actively support and encourage individuals to connect with family and friends and to feel included in their chosen communities. This should be based on an individual's interests, identity, heritage and aspirations. Importantly, the focus on ‘valued role’ needs to be one of the individual’s choosing. Services will also work with the wider community to promote participation and inclusion.

The standard emphasises the importance of:

  • promoting a valued role for people with disability in public and private life;
  • connection to family, friends and chosen communities;
  • economic and community participation and associated benefits to the individual and the broader community;
  • participation based on an individual’s interests, identity, heritage, preferences, goals and aspirations (which may change over time); and
  • the role of family, friends, carers, advocates and other organisations in promoting participation and inclusion.

Rights for people

I have the right to participate in my chosen community. I also have the right to decide how I have contact with family, friends and community.

Outcome for people

I follow my interests, with the support of my services, family, friends, carers or advocates.

Standard for service

The service works with individuals and families, friends and carers to promote opportunities for meaningful participation and active inclusion in society.

Indicators of Practice

2:1 The service actively promotes a valued role for people with disability, of their own choosing.

2:2 The service works together with individuals to connect to family, friends and their chosen communities.

2:3 Staff understand, respect and facilitate individual interests and preferences, in relation to work, learning, social activities and community connection over time.

2:4 Where appropriate, the service works with an individual’s family, friends, carer or advocate to promote community connection, inclusion and participation.

2:5 The service works in partnership with other organisations and community members to support individuals to actively participate in their community.

2:6 The service uses strategies that promote community and cultural connection for Aboriginal and Torres Strait Islander people.

3. Individual Outcomes:

Services and supports are assessed, planned, delivered and reviewed to build on individual strengths and enable individuals to reach their goals

Introduction

The intent of this standard is to promote person-centred approaches to service delivery whereby individuals lead and direct their services and supports.

Services used by people with disability are expected to be flexible and tailored to each individual’s strengths and needs and deliver positive outcomes. This includes an individual’s disability as well as the need for service providers to competently recognise and respond to issues related to age, gender, culture, heritage, language, faith, sexual identity, relationship status and other relevant factors.

Achieving individual outcomes requires collaboration between the individual and service provider to ensure active choice and decision-making. This means joint effort based on mutual respect rather than the service making all the decisions. A focus on individual outcomes includes individuals and services working together to review progress against planned and measurable outcomes.

The standard also recognises the potential role, with the individual’s consent, of families, friends, carers and advocates in planning, delivery and review. It encourages active dialogue between an individual, their family, friends, carers and/or advocates and a service regarding the nature of the service or supports provided while a focussing on the minimal restrictive options.

The standard emphasises the importance of:

  • people with disability leading and directing their supports with support from family, friends, carers and advocates (with consent);
  • service planning, implementation and review being based on individual strengths, needs and life goals;
  • collaboration and dialogue,
  • responsiveness to diversity; and
  • options.

Rights for people

I have the right to lead and direct decisions about my life and how the services I use support me.

Outcome for people

I use services and supports which build on my strengths and support me to reach my life goals.

Standard for service

Services and supports are assessed, planned, delivered and reviewed to build on individual strengths and enable individuals to reach their goals.

Indicators of Practice

3:1 The service works together with an individual and, with consent, their family, friends, carer or advocate to identify their strengths, needs and life goals.

3:2 Service planning, provision and review is based on individual choice and is undertaken together with an individual and, with consent, their family, friends, carer or advocate.

3:3 The service plans, delivers and regularly reviews services or supports against measurable life outcomes.

3:4 Service planning and delivery is responsive to diversity including disability, age, gender, culture, heritage, language, faith, sexual identity, relationship status, and other relevant factors.

3:5 The service collaborates with other service providers in planning service delivery and to support internal capacity to respond to diverse needs.

4. Feedback and Complaints:

Regular feedback is sought and used to inform individual and organisation-wide service reviews and improvement.

Introduction

The intent of this standard is to ensure that both positive and negative feedback, complaints and disputes are effectively handled and seen as opportunities for improvement. To meet this standard, service providers are required to have clearly communicated and effective systems in place to address and resolve issues raised by individuals, families, friends, carers and advocates.

This standard recognises that robust and timely feedback, including compliments and complaints, is a key driver for continuous improvement. Services should have a range of opportunities to seek feedback from individuals ranging from day to day feedback, formal consultation & engagement, regular satisfaction surveys or consumer groups.

In addition, this standard recognises that people need to feel safe to make a complaint or provide negative feedback. This includes being able to access independent mechanisms for complaints, appeals or disputes without fear of adverse consequences or loss of service. The standard also includes being able to have access to advocates and independent information, support, advice and representation.

The standard emphasises the importance of:

  • clear and regular communication about how to provide feedback including how to make a complaint;
  • the use of feedback and complaints to continuously drive service improvements;
  • regular, proactive and inclusive feedback systems;
  • effective complaints management and resolution;
  • transparent dispute management; and
  • access to independent information, support, advice and representation to ensure people are able to provide feedback or make a complaint.

Rights for people

I have the right and freedom to give positive and negative feedback about all aspects of my supports and services and expect to see improvements as a result. I also have the right to independent advice and support to provide feedback or make a complaint when I need it.

Outcomes for people

I have a range of ways to speak up about my supports and services and play an active role in working out how things will improve. I know how to access independent support and advice when providing feedback or making a complaint.

Standard for service

Regular feedback is sought and used to inform individual and organisation-wide service reviews and improvement.

Indicators of Practice

4:1 Individuals, families, friends, carers and advocates are actively supported to provide feedback, make a complaint or resolve a dispute without fear of adverse consequences.

4:2 Feedback mechanisms including complaints resolution, and how to access independent support, advice & representation are clearly communicated to individuals, families, friends, carers and advocates.

4:3 Complaints are resolved together with the individual, family, friends, carer or advocate in a proactive and timely manner.

4:4 The service seeks and, in conjunction with individuals, families, friends, carers and advocates, reviews feedback on service provision and supports on a regular basis as part of continuous improvement.

4:5 The service develops a culture of continuous improvement using compliments, feedback and complaints to plan, deliver and review services for individuals and the community.

4:6 The service effectively manages disputes.

5. Service Access:

The service manages access, commencement and leaving a service in a transparent, fair, equal and responsive way.

Introduction

The intent of this standard is to ensure that access to services and supports is fair, equal and transparent so that, individuals are supported when services are not available and barriers to access are identified and removed. The standard applies across service entry or commencement, service use and, where relevant, exit or leaving a service processes.

Access to services and supports is dependent on a range of factors, including location; an individual’s identified needs; and the resource capacity of a service.

This standard recognises that individuals should be supported to understand criteria and processes regarding access to, and use of, a service. This also includes clear explanations when a service is not available to an individual and referral to alternative service options.

The standard emphasises the importance of:

  • accessible information to respond to diversity of need;
  • transparent and consistently applied service commencement and leaving a service processes;
  • information provision and active referral when a service is not available;
  • the value of partnerships with other agencies and relevant community members to enable referral; and
  • regular reviews to identify and respond to any potential barriers to access.

Rights for people

I have the right to access services based on fair and equal and transparent criteria, and support for referral when a service is not available.

Outcomes for people

I understand what the service offers; access to the service is fair and equal and I am supported with other options when I can’t access a service.

Standard for service

The service manages access, commencement and leaving a service in a transparent, fair and equal and responsive way.

Indicators of practice

5:1 The service systematically seeks and uses input from people with disability, their families, friends and carers to ensure access is fair and equal and transparent.

5:2 The service provides accessible information in a range of formats about the types and quality of services available.

5:3 The service develops, applies, reviews and communicates commencement and leaving a service processes.

5:4 The service develops, applies and reviews policies and practices related to eligibility criteria, priority of access and waiting lists.

5:5 The service monitors and addresses potential barriers to access.

5:6 The service provides clear explanations when a service is not available along with information and referral support for alternative access.

5:7 The service collaborates with other relevant organisations and community members to establish and maintain a referral network.

6. Service Management:

The service has effective and accountable service management and leadership to maximise outcomes for individuals.

Introduction

The intent of this standard is to ensure that services are managed effectively and efficiently. It requires services to be person-centred and to ensure flexibility to respond to individual strengths and needs. It also requires services to promote a culture of continuous improvement as a basis for quality service delivery.

A range of systems and processes are required to support quality service provision and these are reflected in the standard. The standard refers to the active involvement of people with disability, families, friends, carers and advocates in service and support planning, delivery and review. Support for organisational learning and skills development is considered integral to a culture of quality service delivery and continuous improvement. This includes support and training for staff and volunteers. Additionally, service delivery that is reflective in practice and based on contemporary evidence will support the best possible outcomes for individuals.

Adherence to workplace related legislative and regulatory frameworks is an expectation within the standard. This will support accountability through sound governance and enable services to be delivered in a safe environment by appropriately qualified and supervised personnel.

The standard emphasises the importance of:

  • sound governance and management in all aspects of service planning, development and provision;
  • clear communication to staff, people with disability and other stakeholders;
  • continuous improvement and evidence based practice;
  • a range of methods for active participation of people with disability and their family, friends, carers and advocates in planning, delivery and review at the individual, service and organisational levels; and
  • compliance with workplace related legislation and regulation including Work Health Safety, human resource management and financial management.

Rights for people

I have the right to services and supports that are effectively managed, regularly reviewed, accountable and contemporary.

Outcome for people

My strengths and needs are effectively supported through soundly managed services.

Standard for service

The service has effective and accountable service management and leadership to maximise outcomes for individuals

Indicators of practice

6:1 Frontline staff, management and governing bodies are suitably qualified, skilled and supported.

6:2 Practice is based on evidence and minimal restrictive options and complies with legislative, regulatory and contractual requirements.

6:3 The service documents, monitors and effectively uses management systems including Work Health Safety, human resource management and financial management.

6:4 The service has monitoring feedback, learning and reflection processes which support continuous improvement.

6:5 The service has a clearly communicated organisational vision, mission and values which are consistent with contemporary practice.

6:6 The service has systems to strengthen and maintain organisational capabilities to directly support the achievement of individual goals and outcomes.

6:7 The service uses person-centred approaches including the active involvement of people with disability, families, friends, carers and advocates to review policies, practices, procedures and service provision

 

 

Attendant care industry standards

Background

The Attendant Care Industry Association (ACIA) was established in 2005 with seed funding from the New South Wales Motor Accidents Authority (MAA). One of the conditions associated with this funding required ACIA to investigate the development of attendant care industry standards. Over the first 18 months of its existence, ACIA considered how these standards could be developed and by whom.

The need for one agreed set of generic attendant care standards was highlighted by individual service providers experiencing difficulties in meeting the varying requirements of the range of government and other agencies involved in the funding of attendant care services. The development of the standards recognised industry growth. New funding bodies and service providers were entering the field. It further recognised the need for common agreement on what constitutes appropriate standards for the industry together with efficient ways of demonstrating the achievement of those standards for both small and large service providers.

The Attendant Care Industry Standard (ACIS)

The ACIS is the national quality management systems standard that has been specifically designed by the attendant care sector, for the attendant care sector. The ACIS focuses on the key issues required to deliver high quality individualised attendant care in the community. It is applicable to any individual requiring low, moderate or high levels of support to live in their home and community and is not limited in scope to any one particular government department or funder. Achieving ACIA-endorsed certification to the ACIS is a rigorous undertaking that requires service providers to achieve demonstrable quality outcomes for service users.

Guiding principles and standards

Below are the guiding principles and the standards. They are in four parts:

  • Part 1 – Service User Rights and Responsibilities
  • Part 2 – Organisational Management
  • Part 3 – Service Provision
  • Part 4 – Work Environment

Guiding principles

Guiding principles

The Attendant Care Industry Standard defines the quality requirements that shall be attained by a service provider.

The implementation of the Attendant Care Industry Standard requires demonstrated consideration and acceptance of the following general principles:

  • The welfare and interests of the service user should be considered paramount.
  • The service user has the right to make decisions and take actions.
  • The delivery of services is aligned with the requirements/scope of the relevant funding body and contract.
  • Service users have the right to be treated with respect and dignity, and as such not be exposed to abuse, neglect or exploitation.
  • Service provision should respect the capacities of the service user and promote self-reliance and independence.
  • Service provision should facilitate the rights of the service user to participate in social, community and family activities.
  • The family relationships, cultural and linguistic environment of the Service Users should be respected.
  • Service users are enabled to direct the planning of their services, and wherever possible the provision of their services
  • The delivery of services should strive to achieve outcomes desired by the service user.
  • Services should be tailored to the individual Service User’s requirements, and may involve: rehabilitation; maintenance of function; prevent functional deterioration; assist in the acquisition of skills to maximise independence.
  • In programs where the funder has determined “Consumer Directed Care” as a requirement of service delivery, the outcomes and goals may vary greatly and protocols will be in place to meet the requirement including escalated risk.


1.1 Service User Rights and Responsibilities

Outcome - Service users receive services in accordance with their rights and legislation and are facilitated to take appropriate responsibility within their role in the attendant care process. The level of involvement of the service user may vary with “Consumer Directed Care” Programs.

1.2 Individual Values and Beliefs

Outcome - Service users receive services in a manner that respects their values and beliefs. (Refer 2.7)

1.3 Abuse and Neglect

Outcome - Service users are not subject to abuse or neglect as a result of service delivery.

1.4 Confidentiality

Outcome - Service user confidentiality is maintained.

1.5 Independence and Informed Choice

Outcome - Service users are supported to make informed choices, to exercise control over their lives and to maximise their independence during the course of service delivery

1.6 Participation

Outcome - Service users are supported to participate in the community in ways that are important and beneficial to them.

2.1 Governance and Operational Management

Outcome - The service provider has effective and efficient governance and operational management.

2.2 Risk Management

Outcome – The service provider has a system that effectively manages all organisational risks

2.3 Quality Management

Outcome - The service provider ensures the delivery of high quality care and service through the implementation of a quality management system.

2.4 Adverse Event Reporting

Outcome - All adverse, unplanned or untoward events are systematically recorded by the service provider. When necessary or appropriate, advisory notices are given to statutory agencies.

2.5 Complaints Management

Outcome - The service provider has an effective complaints management system that is accessible to service users.

2.6 Human Resource Management

Outcome - Human resources are managed to enable personnel to deliver services of high quality and low risk.

2.7 Responsive Services

Outcome - Service users receive flexible, consistent and reliable support services that are responsive to their individual needs and expressed wishes. (Refer 1.2)

3.1 Service Provider Information

Outcome – Each service user is provided with comprehensive information that clearly describes the services he or she is to receive.

3.2 Service Access

Outcome – Each service user is treated in a fair and equitable manner when seeking access to services.

3.3 Assessment for Individual Service Planning

Outcome - The needs of each service user are identified, with the involvement of the service user, and recorded in an individual service plan that reflects their individual needs and the requirements and parameters of the funding program.

3.4 Individual Service Agreements

Outcome - Each service user has a written agreement with the provider for the provision of service.

3.5 Individual Service Plans

Outcome – Each service user has an individualised service plan that describes his or her identified support needs and requirements and how identified goals will be achieved.

3.6 Evaluation of Service Plans

Outcome – Each service user has an individual goal-directed service plan that is evaluated in an ongoing manner to ensure it continues to contribute to the achievement of identified goals.

3.7 Exit, Discharge or Transfer

Outcome – Each service user’s exit, discharge or transfer from services is planned and coordinated where possible.

4.1 Safe Working Environment

Outcome - The safety of service users and personnel is promoted and protected during service provision.

4.2 Safeguarding Money and Property

Outcome - The money and property of service users are safeguarded during the provision of services.

4.3 Security of the Home

Outcome - The safety of service users and personnel is not compromised as a consequence of service delivery.

 

 

Attendant care competencies

Introduction

The Lifetime Care and Support Authority (LTCSA) provides lifelong treatment, rehabilitation and care to meet Service Users in their injury-related needs caused by motor vehicle accidents.

Ageing, Disability and Home Care (ADHC), Department of Family & Community Services NSW, provides services and support to older people, people with a disability and their families and carers in NSW. ADHC administers the Attendant Care Program (ACP) and High Needs Pool (HNP) for people with high level personal care and support needs across NSW.

LTCSA and ADHC both provide attendant care for people who have a variety of high care needs in the community.

Both LTCSA and ADHC have identified that there is a lack of consistency in the skill and capacity of attendant care workers and service providers to work in a proactive, outcome-focused manner to support people with ABI and/or SCI to achieve their independence goals.

 Recommended skills and knowledge base for ACWs – to be established prior to undertaking training /assessment in competencies outlined in the framework

The recommended skills and knowledge required prior to undertaking competency training are listed below. It is presumed these would be addressed in service provider induction programs or gained through prior experience or training of the ACW.

 

Prior knowledge

Prior knowledge of:

  • Meaning of Duty of Care, confidentiality of information and ethical decision-making in relation to the work role, duties and responsibilities of the Service Provider; what constitutes a breach of these and potential ramifications of such a breach
  • Broad implications of relevant legislation, including privacy, access and equity, anti-discrimination
  • Principles underpinning client-centred health care
  • Principles of client safety
  • Role, function and objectives of the organisation, and relevance to specific work role
  • Organisation procedures relating to fire safety, emergency response, security
  • Purpose  of quality improvement practice
  • Broad understanding of relevant organisation procedures, policies, awards, standards and legislation and how to access them
  • Basic knowledge of employment terms and conditions in the workplace

Prior skills

Prior skills

  • Demonstrate functional literacy skills needed for written and oral information about workplace requirements
  • Demonstrate communication skills as required by specific work role, including: - interpreting and following verbal and/or written instructions
  • Providing appropriate information to both service user and service provider
  • reporting incidents in line with organisation requirements
  • Accurately follow procedures relating to personal hygiene and personal protective equipment.
  • Apply decision-making and problem solving skills as required to constructively achieve identified outcomes in line with work role
  • Use initiative in responding to challenging situations and individuals
  • Take a responsible approach to professional development including maintaining own skills, knowledge and ongoing development
  • Being open to learning new ideas and techniques in a range of settings and sharing workplace information with others

Competencies

Competency 1
The Attendant Care Worker will demonstrate sufficient knowledge of the effects of a spinal cord injury and relate these to changes in physical and psychosocial functioning.

Competency 2
The Attendant Care Worker will identify the anatomy of the brain and explain the subsequent effects of a brain injury on physical, psychological and cognitive function.

Competency 3
The Attendant Care Worker will safely demonstrate effective manual handling techniques.

Competency 4
The Attendant Care Worker will safely and effectively carry out personal hygiene and grooming for Service Users.

Competency 5
The Attendant Care Worker will assist in the maintenance of continence for the Service User.

Competency 6
The Attendant Care Worker understands and applies the principles of skin care to maintain Service User’s skin integrity.

Competency 7
The Attendant Care Worker will safely and effectively assist the Service User to maintain their nutritional status.

Competency 8
Operating within their scope of practice, the Attendant Care Worker will assist the Service User with required and prescribed medications (including regular oral medications, insulin, anti-epileptic and seizure protocols and auto injector devices).

Competency 9
The Attendant Care Worker will follow work health and safety procedures for direct care work in community settings. This encompasses the safety of the Attendant Care Worker, Service User and members of the community.

Competency 10
The Attendant Care Worker has an understanding of the principles and application of infection control measures within the Service User’s environment.

Psychosocial Skills including Interpersonal Relationships and Communication Skills

Competency 11
The Attendant Care Worker demonstrates effective communication skills with key stakeholders.

Competency 12
The Attendant Care Worker has an understanding of Service User’s needs relating to the Service Users psychological, social and mental wellbeing.

Competency 13
The Attendant Care Worker can identify and respond effectively to Service User’s behaviours of concern (difficult or challenging behaviour).

 

1.Communicate effectively in settings related to Service User support
  • Use appropriate personal skills in communication which meets organisational standards
  • Maintain confidentiality of Service Users, staff, organisations and personal information
  • C omply with workplace policies and procedures in all workplace communication to support accuracy and clarity
  • Identify communication style to enhance a Service User centred approach
2. Provide appropriate level of support for Service User
  • Recognise and work in accordance with  the philosophy of
    • Service User directed support
    • Person centred support
    • Enabling Service User to maximise independence
  • Contribute to the setting of Service User goals as appropriate to organisational policies and procedures
  • Facilitate the achievement of Service User goals through application of goal setting and planning principles
  • Articulate Attendant Care Worker role responsibility and role to Service User and family
  • Encourage Service User to participate in making decisions about their support and service plan and work within that scope
  • Seek feedback from Service User related to support provided and ways to achieve optimum independence
  • Provide positive feedback in a supportive manner appropriate to the individual
3. Use specific communication techniques to assist in resolving conflict
  • Use strategies to facilitate conflict resolution
  • Use communication skills and processes to identify and address barriers to communication
  • Explore issues and background to the conflict
  • Use effective skills in listening, reframing, providing feedback and negotiation to support exploration and clarification of the issues
  • Seek agreement on processes to be followed to resolve conflict within the scope of own abilities, skills and work role.
  • Refer to Supervisor for assistance with conflict resolution or mediation as appropriate.
    4. Communicate effectively with Supervisor or Service Provider
  • Inform Supervisor of changes or concerns related to Service User status or provision of support
  • Recognise need to discuss any proposed modifications to Service User service plan
  • Understand roles and responsibility of Service Provider, Supervisor and Attendant Care Worker, and follow correct reporting procedure
  • Understand and maintain appropriate professional boundaries in relation to provision of Service Users support and organisational policies and procedures
  • Take responsibility for communicating own training needs, professional development requests to Supervisor

Competency 12 :

The Attendant Care Worker has an understanding of Service User’s needs relating to the Service Users psychological, social and mental wellbeing.

1. Recognition of stages and features of grief and loss associated with ABI and SCI
  • Can recognise the stages and features of grief and loss
  • Consider how grief and loss and other effects of injury affects Service Users and family members
2. Has an understanding of possible psychological states caused by response to injury (ABI or SCI):
    • Understands the signs and symptoms of psychological states or responses including:
      • Anger
      • Denial
      • Depression
      • Withdrawal
      • Confusion
      • Addictive behaviours
      • Helplessness, apathy
    3. Provide support as appropriate
  • Assist Service User by encouraging Service User to maintain or develop independence in areas he/she is able to manage
  • Promote sense of self worth
  • Reinforce the purpose of goals in service plan and achievements
  • Emphasize and encourage building of support networks as appropriate
4. Recognise when referral to Supervisor is required
  • Recognise when concerns or issues should be reported to Supervisor
  • Report concerns in accordance with organisational policies and procedures and in a timely manner

Competency 13 :

The Attendant Care Worker can identify and respond effectively to Service User’s behaviours of concern (difficult or challenging behaviour).

1. Follow daily routine (as per Service plan) to provide structure and support for Service User
  • Provide a safe and predictable environment for Service Users
  • Identify opportunities for enjoyable experiences within daily routines
  • Consider Service User’s individual needs, strengths and preferences when engaging in daily routines and activities
  • Contribute to an environment conducive to positive and adaptable responses
  • Use reinforcement and encouragement as appropriate to the individual
    2. Identify triggers to the development of behaviours of concern/ challenging behaviours
  • Observe and record the type, frequency and triggers of behaviour likely to put the Service User and/or others at risk of harm
  • Observe and record the environmental context of behaviour developing
  • Observe and record Service User’s personal emotional wellbeing and health status in the context of current behaviour.
  • Consider ways in which the Attendant Care Worker’s actions or responses may have contributed to behaviours of concern
    3. Plan response
  • Identify appropriate response to potential instances of behaviours of concern in line with work role and organisational policies and procedures
  • Ensure planned responses to behaviours of concern maximise the availability and input of other appropriate staff and resources
  • Give priority to safety of self and others in responding to behaviours of concern
4. Apply response
  • Ensure response to instances of behaviours of concern reflect organisational policies and procedures
  • Seek assistance as required
  • Deal with behaviours of concern promptly, firmly and diplomatically in accordance with organisational policy and procedures
  • Use communication effectively to achieve desired outcomes
  • Select appropriate strategies to suit particular instances of difficult or challenging behaviour
    5. Report and review incidents
  • Report incidents according to organisational policies and procedures
  • Review incidents with appropriate staff and offer suggestions appropriate to the area of responsibility
  • Access and participate in available debriefing mechanism and associated support and/or development activities
  • Contribute to the development of prevention strategies and early recognition of behaviours of concern documented in the Service Plan