Attendant Care Provider Brain Injury

I’ll talk with them and their families about what their needs are and what they want from the service. We’ll recruit or roster, select our available staff who we think would be appropriate to meet that person’s needs. We’d work out what time they need support, what they want to have happening during that time and we’d train the staff to do that and then we’d provide an ongoing support to the staff and to the family and the client to make sure that they are getting what they want out of the service.

We are an acquired brain injury services which means that we service specifically for people with an acquired brain injury. Many other attendant care services work with people with all manner of disabilities whether it is aged care dementia, intellectual disability, spinal cord injury, that sort of thing. We feel that people with a brain injury have their own specific set of needs and challenges facing them and that they benefit best from having staff who are experienced working specifically with them.

     Damian, Service Coordination Manager

Starting attendant care. . . I think there is a lot of apprehension, a lot of excitement. Often the excitement is soon overshadowed by reality and then things generally… Things are very-very positive the first couple of weeks generally and it’s great to be home and everything is great and then clients and their families realise that this is a lot harder, it’s very intrusive having attendant care coming to your home. So, they have to deal with that. Plus they are having to deal with “My son or My daughter or My spouse doesn’t have the same role that they used to have in this family”. So, there is coming to terms with all those kinds of emotions as well. So, it’s a very emotional time. It’s a very trying time.

      Justine, Service Coordination Manager

ON SCREEN: Attendant Care Provider Brain Injury

DAMIAN: It can be difficult working in a client’s home like that because there are certain things that we have to do particularly around manual handling and personal care. We’ve got OH&S procedures that we have to follow because we need to make sure that our staff is safe and the client is safe.

DAMIAN: I’m a service coordination manager. What that means is that I coordinate the service for our clients which means that I often assess clients as they are referred to our service.

ON SCREEN: DAMIAN Service Coordination Manager

DAMIAN: I’ll talk with them and their families about what their needs are and what they want from the service. We’ll recruit or roster, select our available staff who we think would be appropriate to meet that person’s needs. We’d work out what time they need support, what they want to have happen during that time and we’d train the staff to do that and then we’d provide an ongoing support to the staff and to the family and the client to make sure that they are getting what they want out of the service.

We are an acquired brain injury services which means that we service specifically for people with an acquired brain injury. Many other attendant care services work with people with all manner of disabilities whether it is aged care, dementia, intellectual disability, spinal cord injury, that sort of thing. We feel that people with a brain injury have their own specific set of needs and challenges facing them and that they benefit best from having staff who are experienced working specifically with them.

JUSTINE: What was it like for you, Dom?

DOMINIC: At first?

JUSTINE: Yeah.

DOMINIC: Nervous.

JUSTINE: Was it?

DOMINIC: Yeah.

DOMINIC:   Working with a person in a wheelchair is not the easiest thing to do and especially if you have to do physio with them. It’s pretty demanding and you are always worried about his safety and yours at the same time.

JUSTINE: Actually he was very good…

DOMINIC: I’ve been with ABI for almost over 12 years. Everyone I had had an acquired brain injury. They were all different. All had different characters. All were… some in wheelchair, some weren’t in wheelchairs. Some had other issues involved with brain injuries.

ON SCREEN: DOMINIC Community Support Worker

DOMINIC: It’s always nerve-wrecking when you go to someone’s home because you know that the family’s been through a lot of trauma. Let me put it this way. They’ve been through a lot. Their whole life’s been turned upside down. You just don’t know which way to approach it. You know that they’ve been through good things with carers, bad things with carers and support workers. So, you really got to kind of keep your mind open and try to work out some rules that would actually earn their trust with the client and with the family.

The first rule which is probably very important is you’ve got to be reliable. OK? You’ve got to be there on time because they are working with you and around you. So, you got to be there on time. If you can’t be there on time the best thing is to let them know somehow through work, or through the phone calls, or whatever that you’ll be a bit late. But at least you let them know that you are going to be there and you are going to try to be there on time. It’s the number one rule.

You’ve got to respect their privacy and you’ve got to respect their property. What I mean by respecting their property is if you go into the house and you move things around or you do things in their house that you have to do you make sure that you left them the way you put them there. And that helps. The privacy is basically don’t interfere with the family matters, don’t try to stick your beak and try to find out what they are saying or not saying. Just kind of keep your distance and focus on your client.

JUSTINE: What was it like for you Ross going to a new client’s home?

ROSS: Going into a new client’s home I was a bit intimidated because the house was huge for beginners…

JUSTINE: When a new client comes either the executive director or manager will go out to do the initial assessment. And in that assessment we just get information about the client, their support needs, their behaviours, what they need from our service.

ON SCREEN: JUSTINE Service Coordination Manager

JUSTINE: We also, the manager then is responsible for providing staff so we need to recruit. Typically that means we need to recruit a specific type of person for that client - can be due to their cultural background, or can be age appropriate, or maybe gender-specific. So then we do that. Once we found a suitable team of staff we then implement the support in the home. Usually there is a fair bit of training that needs to occur if there is like a physiotherapy program or a behaviour management program. We need to train the staff in that first. Then we send the support workers out into the home. That’s when it gets interesting.

The response from the family and the client can be a bit of a mixed bag. I think there is a lot of apprehension, a lot of excitement. Often the excitement is soon overshadowed by reality and then things generally… Things are very-very positive the first couple of weeks generally and it’s great to be home and everything is great and then clients and their families realise that this is a lot harder, it’s very intrusive having attendant care coming to your home. So, they have to deal with that. Plus they are having to deal with “My son or My daughter or My spouse doesn’t have the same role that they used to have in this family”. So, there is coming to terms with all those kinds of emotions as well. So, it’s a very emotional time. It’s a very trying time.

ROSS: But the wife led me up to where the client was and we just saw him laying out virtually on the bed, not moving, whatever, he had a stroke…

ROSS: It is all about them having their independence and being, fitting them back into the community and socialising like we all do. I’m reasonably relaxed. I introduce myself, tell them where I’m from.

ON SCREEN: ROSS Community Support Worker

ROSS:   Usually they want the help so they are welcoming you in. If it’s a family they’ll explain what’s happening if not we get handovers, we know what’s wrong with the client or what needs to be done, the needs of the client and all that. What you got to do is learn and respect their beliefs, their values, and their needs. And once you do that it’s just clock work. You know, they accept you for your help and you just do your best to support this person.

The family members, some of them are a little demanding, OK? But the majority, they talk to you as a person that is included in this picture let’s say. We are not saying family but in this picture. And they know that you’ve got, your client’s got goals and I’m there to help him reach those goals. They may ask “How is he going?” They may ask “Should he be doing this, should he be doing that?” Getting on with them, and we have that rapport as well, getting on with them is easy if you just be honest with them and tell them “This is the goal where we want to go and this is where he’s up to at the moment”. And make it clear to them that it’s going to take time. We need your help as well to make sure that he is going to reach this goal. It’s not just a one person effort, we all got to join. And once we accept each other as a group to help this person then yeah, the picture is complete, let’s say.

JUSTINE: Do you ever find that you feel pressured to become a friend more than a paid professional support worker?

MANJEET: We have to explain, every time we have to know we can’t do that. We have to follow this so and so procedure…

MANJEET: I’m a community support worker and I’m working in this field for more than a year. And I like to work in this field because I was having relevant qualification, relevant work experience and I really like it.

ON SCREEN: MANJEET Community Support Worker

MANJEET: Sometimes the clients having very serious injuries and they have very challenging behaviours. So, this is the most difficult part which we have to go through but I feel like once you get used to it then you will make yourself confident to deal with the circumstances from different angles. So, it’s up to you the way you face the situation, the way you deal with situations.

I just got to see the first client one was Australian and another one was Sri-Lankan. So, the Sri-Lankan, they were expecting different things and Australian people have their own values and beliefs. And when I went to the Sri-Lankan client she was expecting me, she was treating me as if as a community support worker I will support her more, I will be able to give more priority rather than the other clients and I will accept everything whatever she suggests. I think she is expecting more but I have to explain “No, we can’t do that, that culture, we have to follow the policies and procedures”, but it’s hard. I realised it’s hard for me to work with the clients those who are a little bit relevant to my culture because they are expecting too much.

JUSTINE: I started as a community support worker and the thing I loved most about that was just helping people. It’s the job satisfaction that you get, it’s huge. It’s the feeling you get at the end of the day. And you can get that feeling at the end of every day and still remain professional. I then was promoted to service coordination manager and what I like about that is the fact that I just have that little bit more authority to be able to go above and beyond, it’s outside of the scope of the support worker’s role. Liaising with the families, liaising with the government bodies, being advocates on behalf of the client, liaising with therapists, just making sure that you can be that person to liaise with everybody. You’ve kind of got your fingers in all little different pies so to speak. And we still as part of our role get to do the direct support with the clients. That’s my favourite part of the job. I love being at the client’s home helping them with their rehabilitation, doing all that. But it’s a good balance.

DAMIAN: I really-really enjoy seeing people make gains obviously, achieving the goals that they’ve set or even making some small progress towards them. I do enjoy working with challenging clients. It’s one of those things where it really exercises your ability to think on your feet and to implement the strategies that you know work and try to figure out the best way to get the best result for this client.

DOMINIC: What I like the most about this job is when you go home and you achieved something. I’ll take an example of a client I had and we did some physio. Two weeks ago he was having trouble doing a particular movement with his arm and then with his leg. And I kept urging him on. He was very upset. He wasn’t able to do what he was supposed to do. But I kept saying to him, I gave him some positive outlook and said “Well, that’s normal. You are expected to be doing that and next time you do better”. And that went on for about a week or so and then he started doing what he was supposed to do. And he kind of smiled and he was really happy with himself. When I got home I thought about it and it actually felt good. It felt good that I did something without actually going overboard.

MANJEET: I like the way like we got to adjust to go through different kinds of experiences, sometimes very challenging experiences. And once you do that you feel very comfortable. And sometimes you feel proud of yourself that “Yeah, I have done that, I can make some changes in somebody’s life”.

ROSS: What I like most about it is that you are giving the independence back to the client. They are like you and I. Alright, they’ve got a bit of a malfunction but they want to go see a movie, they want to go out shopping, they want to go picnicking, they want to go see a play. And you just help them along. You are just there supporting them, giving them that independence, advocating for them and just respecting them as a human being. And you get a lot of satisfaction out of that.

DAMIAN: We are pretty good. It was just a matter of making sure that the client knew that there were these new people coming and talking them though the process that I’d have to show each of them the new physio program so they could do it safely with them and the other ways to support them. So, the client was really open to that which was good. And then when we had all the staff come in…

ON SCREEN: Thanks to Acquired Brain Injury Services NSW. Camera & Editing Peter Kirkwood. Produced by Paul Bullen & Peter Kirkwood. www.living-with-attendant-care.info.