Home' Community Care Review : CCR Aug-Spt 2015 Contents or care workers would prefer," Ogrin tells
Community Care Review.
Care workers must also be aware that
they are invading this personal space, and
in some ways turning the home into a
healthcare space, potentially changing what
that environment means to individuals.
"This can be distressing for some
individuals," she says.
From an occupational health and safety
aspect, the home needs to function such
that care can be provided without risk to
the personal safety of the care provider or
client, Ogrin says.
IDENTIFYING KEY RISKS
When discussing what care workers need
to be aware of when providing care in the
home, Ogrin first points to the emotional
impacts on the person.
"The client, family and caregiver
autonomy and choice are at the forefront.
The care worker can give health education
and provide recommendations on
strategies, but ultimately the clients will
decide what they do."
Often it can be distressing for clients
to adjust to and cope with various
elements of their health condition and the
corresponding home care services, such as
learning to manage medications, changes in
their health status and medical technology.
All of this must be considered, Ogrin says.
There are also many environmental risks,
she says, citing hygiene, clutter, pets and
firearms as among potential factors that
need to be considered.
"The house itself can become dangerous
for the client. Consider an elderly client, using
a walker, and having to carry their oxygen
tubes and then walk around the house... the
house itself becomes a safety trap."
Ogrin points out that not all houses are
similar and because of those variations,
some are not adaptable.
Further, other issues can arise from
what is called the 'fragmentation of care'.
With multiple care workers and agencies
delivering care into the one home, there
can be difficulties in communication and
coordination between them. (See panel for
full list of risks).
According to Travis Holland, a safety
consultant who advises community care
organisations, psychological risk factors are
Holland's firm conducted a survey of
the community care workforce in 2013
and found that 36 per cent of respondents
"In community care there is typically
less aggression, because by the time
a client becomes that aggressive they
tend to move into residential aged care.
However, the potential in community care
for serious assaults, when there is no one
there to back up the care worker if things
go wrong, is a significant aspect of the
risk," Holland tells CCR.
Holland suggests that care workers need
to ensure they are sharing case notes with
each other, so their colleagues can be aware
of any potential triggers for aggressive
behaviour in the client.
"That transfer of information is not very
good in community care services," he says.
"Many care workers tell us they get given
a client's address, name and list of tasks
to do for them, and they just take it from
there. The organisation should have a care
plan that outlines what the client likes,
what their triggers are, the warning signs
they're becoming more agitated, and some
strategies that work to settle them down."
While organisations can be reluctant
for staff to log and share this kind of
information -- typically due to privacy
concerns -- Holland argues that staff don't
need to know the client's full history but
they do need to know "current active
triggers" that lead to aggressive behaviour,
and what to do when incidents arise.
For Ogrin, preparing care staff for the
diversity of the work environments they
will encounter is of paramount importance.
"Our organisation undertakes site
assessments of clients' homes, going over
a checklist of common issues, to ensure
staff safety. Any issues are worked out with
the client and/or their family," she says.
Ogrin says having the resources to
access information remotely, and access
to equipment needed for care, is also
imperative. For example, she points to
antiseptic hand gels, and clients obtaining
equipment through suppliers that deliver,
negating the need for staff to have to
More broadly, Holland argues that care
workers need to more frequently report
"the smaller stuff" or incidents of minor
aggression, rather than waiting for major
issues to arise. This way, managers can
gain an understanding of how behaviour is
changing over time, and equip and support
While most organisations have
standard incident report forms, these can
take up to 20 minutes to complete and so
would likely be unsuitable for recording
more minor issues. He recommends that
organisations look at implementing a
60-second online report, where staff can
quickly log key facts about an incident
without going into detail. He suggests
organisations try using SurveyMonkey,
which is free, for a few months before
investing in software.
Similarly, Ogrin says that mechanisms
must be in place to ensure that, if issues
arise, there are clear processes to address
them in a timely way. RDNS has an electronic
system in place to report any adverse
event, or 'near misses' with clear processes
in place to ensure they are followed up
and addressed to prevent recurrence.
"Communication is key," she says. n
Dr Rajna Ogrin
The potential in
community care for
serious assaults, when
there is no one there
to back up the care
worker if things go
wrong, is a significant
aspect of the risk.
had experienced one or more incidents
involving aggression and/or violence
during the previous 30 days. Of these
reported incidents, 30 per cent resulted
in the worker reportedly suffering a
Some 85 per cent of the 1,059 respondents
to Holland's survey were direct care workers,
with 52 per cent coming from community
aged care, and the remainder from other
community sectors such as disability.
When asked who was the source of the
aggressive behaviour, most respondents
said it was the client (58 per cent) followed
by a colleague (19 per cent) and family
member (15 per cent).
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