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Aged Care NT, Induction. Facilitator Guide

Aged Care Induction

Facilitator Guide


Acknowledgment

The Aged Care WIN program is managed by the Community Services and Health Industry Skills Council in

consultation with industry

The Aged Care WIN project is a key activity within the national $10 million Aged Care Innovation Project–

aimed at ensuring Australia has a qualified Aged Care workforce to meet the needs of all Australians.

This work has been produced with the assistance of funding provided by the Commonwealth Government

through the Department of Industry. This funding has been provided by the Department of Industry to the

CS&HISC as part of the Aged Care WIN Program The WIN NT project team would like to acknowledge Human Services Training Advisory Council for their assistance in the development of this resource.

Disclaimer Care has been taken in the preparation of the material in this document, but, to the extent permitted by law, Aged Care WINand the original developer do not warrant that any licensing or registration requirements specified in this document are either complete or up‐to‐date for your State or Territory or that the information contained in this document is error‐free or fit for any particular purpose. To the extent permitted by law, Aged Care WIN and the original developer do not accept any liability for any damage or loss (including loss of profits, loss of revenue, indirect and consequential loss) incurred by any person as a result of relying on the information contained in this document. The information is provided on the basis that all persons accessing the information contained in this document undertake responsibility for assessing the relevance and accuracy of its content. If this information appears online, no responsibility is taken for any information or services which may appear on any linked websites, or other linked information sources, that are not controlled by WIN Aged Care. Use of versions of this document made available online or in other electronic formats is subject to the applicable terms of use.

Published by: Human Services Training Advisory Council

Level 2 / 41 Smith Street Darwin NT 0800 Phone: +61 08 8981 2550 Email: [email protected]

First published: June 2014

Version: 1

Release date: June 2014


Contents

About this Guide ........................................................................................................................ 4

Workshop preparation ............................................................................................................... 5

Workshop learning methodology .............................................................................................. 5

Additional readings and references ........................................................................................... 7

Support Organisations for the Aged Care Industry – Northern Territory ............................. 7

Case Studies for Manual Handling: Facilitators Notes ............................................................ 10

Elder Abuse .............................................................................................................................. 13

Case Study – The Girl and the Sailor ........................................................................................ 17

The Girl & The Sailor – a story ............................................................................................. 19

Workplace Health & Safety ...................................................................................................... 20

Safe Food Handling .................................................................................................................. 24

Session Plan—Aged Care Induction ......................................................................................... 31


About this Guide This facilitator guide has been developed to assist in the delivery of a 2‐day workshop style training activity that is intended for the new workers in the Aged Care industry of the Northern Territory. The materials presented have been developed as part of the Aged Care Innovation Project ‐ aimed at ensuring Australia has a qualified Aged Care workforce to meet the needs of all Australians. As an induction programme that will be delivered to workers in a diverse range of roles and from multiple employers, the content and intended outcomes are generic. Employer or organisational specific information is to be addressed with participants as part of their employment relationship with their respective employers. It is expected that prior to attending in this induction participants will have completed an organisational inductions or orientation. Nothing in the delivery of this workshop should be taken as definitive direction for the purpose of defence of behaviour or actions taken in a workplace. Whilst the context of the materials is largely targeted to workers in residential facilities it can be adapted for the community care sector as required. The guide includes implementation advice and a detailed session plan that should be reviewed in conjunction with the presentation slides and participant workbook. Some additional resources and reference materials are noted for the purpose of pre‐reading, and advice to participants seeking more detailed information on specific areas. The session plan is intentionally detailed to provide a ‘commentary’ for each presenter to achieve some consistency in outcomes, however it is recognised that changes may be made to suit environment and learners needs. Any significant changes should be discussed with HSTAC (WIN) as the owner (agent) of this resource. There is an expectation that the facilitator has sound experience in working within the Health & Community Services Industry as well as an ability to facilitate learning in a workshop environment with learners of diverse backgrounds, roles and learning styles.


Workshop preparation The induction programme is for delivery over two consecutive days. Delivery environment will require a facility with access to:

Learner work spaces

Data projection facility

Internet access

Sufficient room for group activity

Flip charts (2) & white board

Laptop for presentation slides

Laptop that has a DVD drive or a DVD player In addition to the equipment for facilitation, a kit of resources is needed which will include:

Participant manual per participant, plus one for facilitator

Pens/coloured markers

DVD – Meerkats

Facilitator Guide, inclusive of session plan

Power point presentation

Ingredients & equipment for food handling activity

Handouts

Attendance register

Quiz & evaluation form per participant It is recommended that tea, coffee & water are available to participants throughout the day. There is no specific pre‐reading or preparation required of participants, however it is expected that they have attended some form of organisational induction prior to attending this workshop. ‘Housekeeping matters’ including emergency evacuation, smoking areas and facilities will be adapted to the venue for each workshop. The facilitator must abide by guidelines provided by a host venue.

Workshop learning methodology The 2 day workshop is to be run on consecutive days, commencing 8.30 am through to 5.00pm with breaks where appropriate. Content is presented in ‘sessional chunks’ that are intended to address the subject matter identified by industry stakeholders as being important for effective participation in the aged care industry. A focus has been given to what has been identified as what an individual ‘must know’ around each subject. Some effort has been made to note items that should be treated as ‘transferrable’ to a specific workplace. The transfer of knowledge and application of skill is the responsibility of individual participants, however is highly recommended by the WIN /NT project team that employers follow up with their respective employees to confirm this transfer.


As the WIN project seeks to identify more innovative ways to engage, develop and retain their workforce effort has been given to provide a workshop that is interactive, creative and engaging. Creating links to between activities and learning objectives is at the skill of the facilitator along with ensuring active participation of all attendees.


Additional readings and references Information in the following sections is provided as pre‐reading and reference prior to workshop facilitation. Specific sections will have information that is relevant to activities within the workshop for effectively responding to questions and group discussions.

Support Organisations for the Aged Care Industry – Northern Territory

The Aged & Community Services Industry in the Northern Territory is made up of various stakeholders who represent employer (peak bodies, government departments, employees (unions, industry networks) and those who are being cared for as clients / residents (specialist services, government agencies and service providers). Government services span the range of Local, Territory or Federal, and their contribution will vary. The following information is a sample of these stakeholder groups. As at this point (May 2014) responsibility for Ageing and Aged Care sits with the Department of Social Services. This follows significant review and reform implementation that is linked to the Aged Care Reform Act that was adopted in 2012. Provision of services is shared across two distinct functions – residential care and home & community care. Residential care addresses the needs of those who can no longer remain at home. Varying levels of assistance are available from the low to high – the need for direct contact with medical and personal support care are features of these different services. Home & community care provides assistance to those who may still be living at home but need help with personal care and home tasks, or to have visits from medical professional. Access to services will vary from location to location and is impacted on the availability of some funding arrangements. To ensure a consistency in the standards that are offered by aged care service providers, standards are in place that must be maintained to allow for continued operation. Standards exist for both types of services (residential and home/community care) and administering these is the responsibility of the Australian Aged Care Quality Agency. In addition those in need of assistance are more involved in the choices being made about their care plans through the Living Longer, Living Better package of services that commences in July 2013. It is this shift towards tighter mandatory regulation combined with the element of choice that has contributed to the focus on consumer directed care for aged care services. Within the NT, there are a number of organisations or peak bodies that operate to represent stakeholder groups working in the aged care sector.


Aged & Community Services SA & NT ACS is a well‐established not‐for‐profit industry peak body recognised nationally for knowledge, influence and expertise in the aged care sector. By advocating on behalf of members and providing them with practical assistance and the ultimate goal is to support people to live life to the full and flourish while ageing. NTCOSS ‐ The Northern Territory Council of Social Service (NTCOSS) is a peak body for the Social and Community Sector in the NT and an advocate for social justice on behalf of people and communities in the NT, who may be affected by poverty and disadvantage. Council of the Ageing (COTA) As a representative organisation, the role of COTA is to promote, improve and protect the circumstances and wellbeing of older people in Australia. Their work draws on views of today’s seniors and on concerns for future generations of Australians. Alzheimer’s Australia NT Provides support, counselling, information and education to help people living with dementia, their families and those working in the dementia field. Health Services Union (HSU) is an employee organisation providing advice on employment relationship difficulties or challenges in the workplace. The South Australian branch of the union is made up of health professionals working in a range of fields in the healthcare and aged care industries. (is there no NT branch?) HESTA is the industry superannuation fund for the benefit of members working in the Health Services industry. They can assist with referrals for financial planning, retirement and insurance options. Aged care residential accommodation is funded through the Federal Government. At June 30, 2013 the Northern Territory had provision for 1,707 ‘beds’. The service may exist in the form of aged care facility (home), hostel, respite care, ….(still not sure I am getting the words right!!!) Providers of residential accommodation services for the aged care sector in the NT include:

Southern Cross Care (SA & NT) Pearl Supported Care – Fannie Bay

ECH Tiwi Residential Care Centre ‐ Tiwi

Hetti Perkins Home for the Aged ‐ Alice Springs

Juninga Centre ‐ Coconut Grove

Kalano Flexible Aged Care Service ‐ Kalano Community, Katherine

Katherine Hostel ‐ Katherine

Mala'la Flexible Aged Care Centre ‐ Maningrida Community, Maningrida

Malandari Flexible Aged Care Service ‐ Borroloola

Mulakunya Flexible Aged Care Service Nguiu, Bathurst Island

Mungkadinamanja Flexible Aged & Disability Service ‐ Angurugu Community

Old Timers Village ‐ Alice Springs


Community Care Services include – who also have ‘beds’ available:

Golden Glow Nursing Services Katherine

Life Without Barriers Alice Springs

Frontier Services Community Care East Arnhem

Southern Cross Care (SA & NT) Pearl Supported Care

Yirrkala Aged & Disability Service

Umbakumba Aged & Disability Service

Ramingining Aged & Disability Service

Gapuwiyak Aged & Disability Service

Galiwin'ku Aged & Disability Service

Nyirranggulung Community Care

Larrakia Nation Aged Care Service

Minyerri Aged Care

Marthakal Homelands Health Service


Case Studies for Manual Handling: Facilitators Notes Consider the following situations and identity the types of risks that may exist and some controls that could be used to reduce the likelihood of an injury to worker or patient. Situation 1 A client with right sided weakness is unstable on his feet and needs help with personal care. He lacks the confidence to transfer and use his affected side. A support worker is to visit him daily. The transfers involve helping the client to stand from the side of his low bed and into the commode or wheelchair. Client stands in the shower and in the bedroom. Some responses to consider: The support worker would have to support the client’s body weight during transfers and also when showering and dressing. Use of a towel to ‘dry down’ and possible shampooing which may lead to slippery floors. If the same support worker is coming in daily, this increases the chance of injury, from over exertion and awkward postures, however changing a person each day may cause distress to the patient and should be considered. Awkward posture with lack of balance is a risk factor and injury could occur at any time during transfers or standing. Raise height of bed on bed blocks and install a bed rail to allow easier transfer from seating to standing. Encourage client to sit for dressing tasks. Stand when pants are partially on using a stable rail to stand and support worker pulls up and secures pants / trousers. Client uses stable hand rail and support worker pushes commode / wheel chair in behind the client for him to lower himself. Use of non slip tiles / mats for wet areas. Rotate two support staff workers each week day. Situation 2 Client lives in a large house with 2 living areas, 2 bathrooms, large kitchen, dining and 3 bedrooms. Support worker is required to vacuum and mop all areas of a large house as part of a 1.5 hour domestic assistance service. The client will ask for extra tasks to help them with their day. One support worker is allocated on weekly basis to clean main bathroom, kitchen and changing and washing of bed linen and the mopping or vacuuming of all rooms. Equipment is old and not fully effective.


Responses to consider: Awkward movement with vacuuming – ensure equipment in good working order. Replace or repair to avoid unnecessary force. Do not use in‐effective equipment. Rotate vacuuming and mopping of areas in the house. Send two support workers for 45 minutes to share tasks. Train support workers to use effective work practices in cleaning and use PPE as appropriate. Ensure suitable lifting of bed linen both dry and wet. Remind workers only to complete tasks on agreed care plan. (Examples from home and community care, NSW) Situation 3 Sea Rest House is a large aged care home with over 200 residents. The home employs many cleaning staff to maintain floors, bathrooms and window surfaces. Many different cleaning chemicals and detergents are needed to keep the place clean and sanitized. The detergents, delivered in 25 litre drums are heavy and awkward to lift and store in the general store room. Chemicals are decanted and diluted into clear smaller bottles for use and labeled for purpose. Staff will move from floor to floor in their cleaning duties across the home and the current practice is to carry buckets and mops, plus other cleaning needs in the bucket as they move around. Some items to consider: Change to a chemical safety system that provides for automated dispensing of chemicals. Bulk chemicals are stored on low shelves in suitable storage facility close to dispense unit. Reduces risk of strain from lifting and risk of chemical splash from dispensing. Chemical bottles are color coded to avoid risk of mis use or mishandling. To assist in moving from one location to another, small dolleys or trolleys can be introduced to avoid risk of strain from lifting and shifting buckets as well as splashing and spillage creating a hazard for slips and falls. Chemicals to be stored in a suitable location – review the ‘general store’ and ensure no proximity or ventilation risks. Situation 4 Support workers and Nurses dress and undress residents frequently throughout a shift, particularly when assisting with toileting. Residents who are incontinent require a complete change of outfit many times in a day. Clothing items can lead to small injuries from scratches or zips or other fastenings.


Some items to consider: Awkward posture needed to assist in dressing and undressing of a person, compounded with potential for person to be upset or distressed or resistant leading to jerky, uncertain movements that may create increased risk. Clothing could be reviewed for those residents with frequent dressing / changes are needed to use back openings that are easier for carers to access, using capes instead of jumpers to avoid lifting of arms. Having access to two people when changing is required can help to balance loads and share tasks. Skin tears increase risk of infection. Use of Velcro fastenings may reduce this risk, or elastic bands and drawstrings as suitable. Making the task of changing clothes easier will assist in preserving dignity of resident.


Elder Abuse

The abuse of older people is a worldwide recognised issue. Relationships of trust include family and friends of the older person but increasingly the relationship between community support workers, such as domiciliary nurses and home help, have come to be recognised as trusting in nature and are therefore covered by this definition. Overview of elder abuse Elder abuse is located within the context of the Domestic and Family Violence paradigm which, along with child abuse and domestic violence, is underpinned by issues of power and control. There are similarities between the three domains of abuse but each stage of life needs its own framework for understanding and addressing specific issues. Research into elder abuse estimates that anywhere from 2.6% to 8% of older people experience some form of elder abuse in any one year; however this could be just the tip of the iceberg. Types and Signs of elder abuse 1. Psychological (emotional, mental, verbal) abuse: is the infliction of mental anguish, fear and feelings of shame and powerlessness. Behaviours include: verbal intimidation, humiliation, harassment, shouting, threats of various forms, withholding of affection and removal of decision‐making powers. Signs include: Loss of interest in self and environment, passivity and apathy towards another person, fearfulness, lack of eye contact, ambivalence or nervousness around another person, reluctance to talk openly, helplessness and resignation. 2. Financial abuse: is the illegal or improper use of an older person’s finances or assets without their informed consent. Behaviours include: misappropriation of assets, money or valuables, forced changes to legal documents, the denial of access to personal funds, forging signatures, misuse of a bank card and misappropriation of an Enduring Power of Attorney. Signs include: loss of valuables, unprecedented transfer of funds, the improper attainment of Enduring Power of Attorney, loss of the bank card or a cheque book and the sudden inability to pay bills or purchase necessities. 3. Physical abuse: is the infliction of physical pain, injury or force and the deprivation of liberty. Behaviours include: slapping, hitting, bruising, pushing and shoving, physically restraining and over & under medicating. Signs include: discrepancies between injury and explanation, burns, bruising, injuries at different stages of healing and being seen by different doctors or hospitals. 4. Social abuse: is the intentional prevention of an older person from having social contact with family or friends or accessing social activities of their choice. Behaviours Include: Moving the older person away from family and friends, forbidding access to visitors, denying the use of the phone or monitoring calls and cutting off activities without explanation and many other controlling behaviours.


Signs include: Unexpected cancellation of services, non‐attendance at activities the person regularly attends, constant and close presence of the carer/family member, a high level of gate‐keeping by the suspected abuser. 5. Sexual abuse: is sexually abusive or exploitative behaviour or any behaviour that makes the older person feel uncomfortable about their body or gender. Behaviours include: rape, indecent assault, sexual harassment, the use of sexually offending language and touching inappropriately Signs include: bruising around genitals, unexplained venereal disease, torn/stained/bloody underclothes, bruising on the inner thighs, difficulty in walking or sitting, huddled and fear of being touched. 6. Neglect: is the failure of a care giver to provide the necessities of life to a person for whom they are caring. Neglect can be unintentional or intentional. Both have the same adverse affect on the abused and cannot be excused or condoned. However, it is important to note the difference between the two types as it assists in choosing the most appropriate interventions. Behaviours include: Unintentional Neglect ‐ when a carer does not have the skills, knowledge or physical ability to care for the person or they lack knowledge of the supports available to them. Intentional Neglect ‐ when an older person is abandoned or not provided with adequate food, clothing or water or when there is a refusal by the carer to allow other people to provide necessary care. Signs include: malnourishment, dehydration, lack of social contact or activities, smelling of poor hygiene, clothing in poor state, colds and chills, lacking glasses, dentures or hearing aids, pressure sores, abandoned.

Risk Factors

∙ Dependency – The older person may fear the loss of the carer or being moved to an aged care facility or of experiencing retaliation if they complain. They could be in a co‐dependant relationship with the abuser. The carer may be dependent on the accommodation and income of the older person. The older person may still be the carer for an intellectually impaired, mentally ill or emotionally immature adult who abuses them.

∙ History of family conflict and dysfunction – could involve many unresolved

issues, learned behaviours through intergenerational violence, a continuation of domestic violence with role reverses or an opportunity for “pay‐back”.

∙ Isolation – no one to get help from and no one to witness the abuse, not being

aware of options and services, no support networks.

∙ Physical health issues – increased dependency or increased burden of care on the carer.


∙ Mental health issues – human rights including confidentiality issues that exclude the carer from information, non‐compliance with medications, conflicting rights and needs between the person and the carer. The older person could experience mental health issues or be living with a person with mental illness.

∙ Impaired capacity ‐ diminished capacity to report and to be believed, increased

opportunity for being abused, increased abuse of the carer due to uncontrolled behaviours, issues of determining capacity or the level of capacity.

∙ Carer stress – may lead to unintentional or intentional abuse. The abusive

actions of carers are not to be condoned, however, the carer could be the abused or in need of information and support.

∙ Addictions – alcohol, prescriptive or illicit drugs or gambling addictions affecting

the older person, the carer or the person who lives with the older person.

∙ Language and cultural barriers – all the risk factors mentioned above could be compounded by increased level of isolation through language barriers and increased dependence due to cultural values, historical influences and/or the emigration experience.

When addressing elder abuse it is important to utilise a holistic, non‐punitive and non‐judgemental approach. In most cases people wish to retain important relationships with significant people, therefore by addressing the unmet needs of the alleged abuser as well as the abused person, the situation could improve for the client. It is also important to recognise that many carers go out of their way to care for the person in their care and they could be the ones who allow themselves’ to be abused, may need information and support, or could experience physical or cognitive health issues. The following page is used as a handout to discuss the United Nations Principles for Older Persons


Information sourced from www.eapu.com.au


Case Study – The Girl and the Sailor This case study is used on day two of the workshop to increase awareness and generate conversation around the diverse nature of contemporary workforces as well as the people that are being cared for as residents / clients in the aged cared industry. Number of Teams & Group Size: Minimum 3 people per group Maximum 7 people per group Logistics Needed: Per Person: 1 x Work Sheet1 x Pen / Pencil For Facilitator: 1 x Whiteboard / Flipchart Stand with A1 Paper 1 x Marker Time Allocated: 20 ‐ 40 minutes Goal: To rank each of the 5 characters in the case study Preparation & Set‐Up: Ensure sufficient copies of the case study and pens / pencils for every participant. Distribute the case study as handouts Directions for Conducting the Activity: Instruct participants to carefully read the case study on the handout Inform participants that they are to rank the 5 characters, with a score of 1 being the person the like the most, a score of 2 being the next person they like, all the way to the lowest score of 5, which is the person they dislike the most. Tell participants that they have to individually rank each character, no discussions are allowed. Once everyone in their group has completed the individual rankings, they are to then discuss and agree upon a group ranking. Allow participants some time to develop their individual rankings (~ 5minutes). Then ask them to discuss as a group for the group rankings, taking some more time to do so (~ 5 ‐ 10 minutes). Call time, and ask each group to present their group rankings for each character. Note their responses on the whiteboard or flipchart paper. Once every group has given their rankings, go round and ask each group to explain the reason why they decided upon this particular ranking. You may share any additional perspectives for ranking the characters. Specific Rules: 1. Participants are to rank the 5 characters, with a score of 5 being the lowest, and a score of 1 being the highest. Each character can only be given 1 score, and no score may be used more than once. 2. Participants are to develop their own individual rankings. Once completed, they are to develop and agree upon a group ranking.


Variations: None Learning Points: Managing Conflict / Compromise Differences in Culture / Values / Beliefs / Upbringing /Seeing from a Different Perspective / Having a common understanding / Agree to Disagree / Accepting Differences / Views of Other People Instructions to Facilitator Be careful not to reveal what you think, or how you would rank the 5 characters to participants, as this would influence their judgement. However, you may reveal your thoughts AFTER the activity has concluded and you have completed the debrief. The gender of the Best Friend character is meant to be ambiguous, if participants ask about this, inform them that they have to make their own decision. Sometimes, you may have most / all groups ranking the characters in a similar manner. In these cases, you may wish to share other perspectives for ranking the characters. Some perspectives as follows: Girl (High Score): Victim, Did what she thought was right, Devoted Girl (Low Score): Foolish, Didn’t plan ahead, Didn’t think of alternatives Sailor (High Score): Business‐like, Honest, Offered a transaction, Most helpful Sailor (Low Score): Thinks of personal gain, took advantage of situation Fiance (High Score): Right to be emotional, Maybe will cool down later Fiance (Low Score): Not understanding, Didn’t try to rescue her Best Friend (High Score): Supportive, Understanding Best Friend (Low Score): Taking advantage of situation, Should talk to Fiance instead of Girl Old Man (High Score): Stayed neutral, didn’t encourage or discourage Old Man (Low Score): Stayed neutral, didn’t help to build boat


The Girl & The Sailor – a story

A ship sank in a Storm. Five survivors scrambled aboard two lifeboats: a sailor, a girl and an old man in one boat; the girl’s fiancé and his best friend in the second. That evening the storm continued, and the two boats separated. The boat with the sailor, the girl, and the old man washed ashore on an island and was wrecked. The next day the weather cleared, and the girl could not locate her fiancé. In the distance she saw another island. Hoping to find her fiancé, she begged the sailor to repair the boat and row her to the other island. The sailor agreed, on the condition that she slept with him that night. Distraught, she went to the old man for advice. “I can’t tell you what’s right or wrong for you,” he said. “Look into your heart and follow it.” Confused but desperate, she agreed to the sailor’s condition. The next morning the sailor fixed the boat and rowed her to the other island. Jumping out of the boat, she ran up the beach into the arms of her fiancé. Then she decided to tell him about the previous night. In a rage, he pushed her aside and said, “Get away from me! I don’t want to see you again!” Weeping, she started to walk slowly down the beach. Her fiancé’s best friend saw her and went to her, put an arm around her, and said “I can tell that you two have had a fight. I’ll try to patch it up, but in the meantime I’ll take care of you.” Instructions Rank in order the following characters from 1 (the person you liked most or valued most) to 5 (the person you disliked or valued least).


Workplace Health & Safety The following case study is for use as part of incident reporting within the section on Workplace Health & Safety. The case study is provided in each participant manual, along with a blank template of a standard incident form (provided by Worksafe NT). Allow time for participants to review the case study as individuals and then have them work in pairs or small groups (up to 4) and complete the incident form. The purpose is to create an awareness of the process of reporting and getting the details as accurate as possible. Words used to record some information will vary. A completed example is provided as a guide. The Incident at Sacred Heart Marion is the manager at a busy Nursing Home called “Sacred Heart”, located on Emerald Street in Darwin City, Northern Territory. On 2nd July 2014, Tarni, one of the Duty Managers was instructed by Marion to supervise the day’s incoming deliveries and to clean out/reorganise the supplies storeroom to create additional space for the extra supply of cleaning products that had been ordered. Tarni got straight to the task, organising the appropriate PPE for herself to get the job done. The day went on with a number of delivery companies coming in and out of the loading dock to drop off supplies. One of the deliveries was quite large and as Tarni was unpacking the chemicals she doubted that the shelfing unit would be able to support the weight of the stock. Nearing 5pm and with the end of the day in sight she rushed to put the stock on the shelf and hurried to meet the next delivery driver, knowing that the shelving looked a little unstable. The delivery driver was Anthony, Tarni recognised him from as a local supplier from “FTT Chemicals”. Anthony offered to wheel the stock into the storeroom to assist Tarni. Anthony was having difficulty fitting the large trolley through the door frame but thought it would be fine with one big shove. Anthony’s trolley knocked the unstable shelving unit and the shelves gave in! The unit came crashing down along with the 2lt bottles of industry grade cleaning bleach it was holding. Tarni heard the commotion and ran over to see if Anthony was ok. He was partially wet from being splashed with chemicals and bleeding from a small graze on his arm. Tarni immediately called for help and ushered Anthony to a seat to tend to his wound. Anthony refused medical assistance assuring Tarni that he was fine and needed to finish the remaining deliveries for the day. Tarni would not allow Anthony to leave until Marion arrived to assess the incident. 5 minutes later when Marion arrived, Anthony was starting to complain that the graze on his arm was stinging. They agreed that it was most likely from the chemicals and Marion sourced


the Material Safety Data Sheets to ensure they were administering the correct care. They then washed and treated the minor cut. Marion gave both Anthony and Tarni an incident form to complete and ensured Anthony left with a copy to give his employer. Marion also ensured that Anthony had her direct contact details should any problems arise. Marion had Tarni finish her shift once she had completed the incident report and set a meeting for the following day to discuss the event and reflect how the situation could have been prevented. Three staff members were called to suit up in appropriate PPE to clean up the chemical spill and dispose of the mess appropriately under the guide of the Material Safety Data Sheets.


Safe Food Handling This activity is designed to have participants learn through an experience about some of the key principles of safe food handling and hygiene. The activity will explore:

Safe use of knives and other kitchen utensils

Principles of food handling & preparation

Kitchen hygiene practices

Team collaboration Activity is to be engaging whilst being instructive. Working in small teams (up to 4 people per team) participants will prepare sandwiches and fruit as a meal for six people. One person to accept the role of team captain. A kit with ingredients and utensils will be supplied to each team and there will also be some ‘common ingredients’ that are shared between teams. Recommend that a minimum of two teams ‘compete’ in the activity and the balance of participants will be observing as ‘judges’. Teams are advised that they have 15 minutes to fully prepare a meal of sandwiches and fruit for six people. They can be as creative as they wish with the ingredients they are provided. Whilst the expectation is to have a platter of mixed sandwiches (1.5 rounds per person) and a fruit platter, this may be subject to the creative interest of the participants. One person should be allocated the role of time keeper. They are to keep all teams advised of the time at five minute intervals and finally before the last minute. When ‘time’ is called, team members must put down tools and present their food as it is. ‘Judging’ should be conducted before the analysis of work practices is done to avoid potential for individuals to feel they are ‘letting a team down’. The awarding of points should be kept to consideration of:

“On time” completion

Look and appeal of final ‘plates’

Creativity

Teamwork 5 points available for each category. Scoring can be done on prepared flip chart. Have participants to return to seats and conduct a discussion around the issues of safe food handling and hygiene.


Discussion should build around the following questions:

What personal protective equipment was used? Gloved, hair nets, aprons

How were the colored chopping boards used – was this accidental or intentional?

Were the food items checked for freshness / expired dates?

What considerations were made for special diets / food allergies?

How well did the team allocate tasks and co‐operate

How well were the knives, graters and other utensils handled?

Were hands washed before, during, after the activity? Issues to be explored:

Cross Contamination Use of same or varied chopping boards for different ingredients. Colored boards are established to general principles:

Hand washing / sanitizing

Was this done at start / during activity. Done by all or some of the team? If hand washing facilities not immediately available, ensure that bottles of hand sanitizer are available for use.

Sanitizing of work spaces / tools

Was the work space prepared as a hygienic space for food preparation? Sanitizing occurs when extreme hot water and or chemicals are applied. This is intended to kill bacteria.

Use of knives and other utensils

Were these handled in a safe manner? (Use of knuckles to protect fingers?) Were they cleaned between use of different products? Were graters cleaned between carrots / cheese?

Food allergies Known food allergies or dietary requirements will be within a care plan. If the plan changes, important to advise the kitchen team. Substitution of other items should not be used unless consultation with dietitian or other professional. Was consideration given to vegetarian / gluten / other dietary needs of ‘guests’.

Storage How were the products / ingredients stored when not in use?


Was the final product wrapped for safety / freshness?

Temperature controls How were the ingredients managed through the activity – returned to appropriate storage?

Ingredients used Were ingredients checked for ‘freshness’ / expiry dates? What if any actions were taken to address either food condition or out of date?

Cuts, injuries / sores

Any cuts, sores, wounds or skin tears should be covered with suitable bandage. In the event of an injury whilst preparing a meal, immediate food may be disposed of to avoid potential for contaminations In some workplaces, the bandages in the kitchen are blue or other colour…so they are clearly visible.


The following equipment and ingredients are to be provided to each team.

Ingredients

1 x loaf sliced break (whole meal / multi grain preferred)

1 carrot – recommend pre‐peeled if available

1 yoghurt flavored 1 yoghurt plain / vanilla

1 x small tub butter / margarine

1 small cucumber 1 small bunch grapes

1 set salt & pepper

1 bottle salad dressing (creamy)

2 mandarins/ small oranges

6 slices slice meats – may be mixed

1 bottle salad dressing (oil based)

2 passion fruit Punnet / quantity of strawberries or other seasonal berry

Half iceberg lettuce (or other lettuce / leaves)

6 boiled eggs (in shell) Skewers / toothpicks

12 slices cheese or small block

2 apples

3 tomatoes – medium sized

Equipment and utensils

1 set of color coded slicing boards*

2 small ramekins 1 small mixing bowl

2 box gloves – medium / small each

1 paring knife 1 bottle hand sanitizer

1 butter knife 1 spatula 1 box / supply of paper towels

1 peeler Box hair nets

1 grater Box cling wrap

1 sandwich platter / plate

1 fruit platter / plate

Additional Instructions to Facilitator: Ingredients can be varied to suit location / season. Food items provided should allow for preparation of 9 rounds of sandwiches of mixed fillings and a small platter of mixed fruits. The ingredients provided should be suitable for audience and intended activity purpose which is to prepare food items and reflect on the practices of preparation. Items are not intended for consumption, but should be suitably wrapped and stored away from the group at end of session.


Disposal of food items to be done with discretion at end of day. Equipment and utensils to be thoroughly cleaned and sanitized at end of use. In the event that any careless or dangerous work practices are noticed, Facilitator must intervene and correct the situation. This may include withdrawing a participant from the activity if the behaviour is considered wilfully negligent or harmful to self or others. A simple first aid box should be on hand. This is part of the learning as well as an important tool in the event of a mishap occurring. If not taken as part of the WIN Induction Kit, then ensure the location of a first aid kit at the training venue has been determined before the workshop as part of preparation and planning. Time management of the activity is critical.


Instruction to the Master Team…


Session Plan—Aged Care Induction The workshop timing is based on an 8.30am start through to a 5.00pm completion time. Breaks are allocated as a guide and may be varied to suit progress of the session, with 15 minutes allocated for morning break, 45 minutes for lunch and 10 minutes for the afternoon break. Room set up should allow for unobstructed line of sight to power point slides and have sufficient space for participants to interact as required for the activities.

Time Topic Content/Activities Resources

8.30

Welcome and Overview

Welcome and introduce self Why are we here? – Purpose and objectives. Review WIN Mission & Welcome Programme Overview: Day 1

The Aged Care Industry – National / Territory

Standards and Regulations – ‘Compliance Matters’

Manual Handling ‐ Care for you and your Customers

Customer Care – providing a service Day 2

Workplace Bullying / Harassment

Workplace Health & Safety

Elder abuse

Safe Food Handling & Hygiene

Infection Control

Planning your pathways

Slide 2 Workbook page 4 & 5 Slide 3



Housekeeping matters: Emergency Exits / Toilets / Smoking / Mobile Phones, attendance and breaks. Interact / Ask Questions / Have Fun! As the workshop progresses, you will be involved in a range of discussions and activities. The workbook provided is for you to record your own notes and responses to some of the questions and activities that span the next two days. Icebreaker Activity: Use an activity that will allow each person to introduce themselves and shift their focus to the workshop. Allow 10 minutes.

9:00 Our Industry – National & Territory perspective

Again, welcome and thank‐you for choosing to be part of the Aged Care Industry for the Northern Territory. The aged and community care sector is one of the largest and fastest growing employers in the Health & Community Services Industry. Because our population is growing. The trouble is people are leaving the workforce. So we have a challenge of demand (for services)….to be met by the supply (of workers).

Slide 4 Workbook page 8 Slide 5



At 2011 Australia’s population reached 22.6 million, and is expected to reach 38.7 million by 2044, just thirty years from now. (growing population) Looking at how long we are living, at present noted at 82 years, with increase to 90 years by 2044. (increased longevity). Q : Why are we living longer? Advances in technology to treat / prevent diseases and improvements to the quality of living. In context of why we are here today, there are 455,390 people within our population at the 85+ years. This is an increase of 4 times from 30 years ago. By 2044 (30 years from now) it is expected that this will increase at 14 times the current rate to have 1,655,997 people of 85+ years plus in our population. (85+ population) These numbers tell us that Australia will have many more people who are living longer, and hence will need the assistance of services to ensure that they are cared for by way of medical treatments, home or residential facility care, transport needs and a range of other services. What does this look like? Research shows, in 1970 we had 15 people in the workforce for every retired couple. At 2010 this was 10 people in workforce for every retired couple. Looking to 2050 expected to reduce even further – to just 5 people in the workforce to every retired couple. (declining workforce ratio) Remember, there are more of us…and less of us in the workforce.

Workbook page 9 The Aged Care Puzzle ‐ demand Workbook page 9 The Aged Care Puzzle ‐ supply



Retirement forecast for the aged care workforce is that HALF of the workforce we have will retire in the next 15 years. 8,015 retirees per year. (mass retirement) So, we need more people into jobs to care for those who are living longer, as well as replacements for those who are themselves retiring from this workforce of aged care support workers. We need 77,976 workers in the next 10 years …650 per month…. (mass recruitment) As already identified, people are living longer. The Australian Government would like to ensure that we are not only living longer, but living better. Through consultation and policy development, we have the Living Longer, Living Better Aged Care Reform package which provides a 10 year plan to provide a better, fairer and more consistent aged care system that will meet the challenges for the nation’s culturally and linguistically diverse ageing population. Review the Living Longer, Living Better flyer. Key components of the reforms include:

help for older people to stay at home

increased support for carers

better residential aged care facilities

strengthening the aged care workforce

more consumer support and research

better health care connections

Handout ‐ Living Longer, Living Better



tackling dementia

supporting older Australians from diverse backgrounds building a better system for the future Caring for our aging population is a high priority at all three levels of government. By choosing to be part of this Industry workforce, you are part of the solution that will help to implement this plan. In the Northern Territory, Aged Care Services includes support and care services for

community based care

home‐care

retirement & lifestyle villages,

independent living

and respite services (Note: the provision of services for those who are carers, rather than those being cared for)

Supporting elderly or frail people to retain the quality of their life is the essential activity common to all these services. In 2014 there are eight key providers with approximately 1,600 aged care beds in total that cover High Care, Low Care, Secure Dementia and Respite services across 11 regions in the Territory. Our focus in this induction programme is on residential care facilities and the associated workplaces but the information largely applies to home care services.

Slide 6 Workbook page 10



The opportunities available in the Northern Territory encompass a wide range of expertise and provide excellent prospects for career development. Possessing an empathetic approach to giving care and a genuine interest in working with the elder community are core attributes for employment. Job roles Our sector is made up of many activities and many job roles. Refer to introductions and the likelihood that different roles are represented here today. Activity: In pairs, create a list of job roles that you are aware of / have observed in your workplace. Present and Discuss – see if the list can reach 30. Allow 5 minutes to generate a list. Ask the group who has 20,25,30 or 30+ with a ‘show of hands’. Get the group with highest list to read them out. Ask others if they have others to add. Not essential to have every job listed, but important to identify the diversity. Some job roles that might be listed:

Support worker

Primary carer

Aged Care Worker

Patient Transport

Food Services

Receptionist

Maintenance Person

Workbook page 10



Medical service provider

Cleaning services

Team Leaders / Supervisors

HR / Management team

Community Liaison Officer

Aboriginal health worker

Allied Health worker Q: What do these jobs have in common? Commitment to providing a quality level of care to those who may be in need and or vulnerable. Q: What skills do you think you need for working in this sector? List on the white board ‐ care / compassion / patience / attention to detail / some medical skill or knowledge / specialist knowledge for some roles / communication / tolerance Q: How does your role interact with these other jobs? Activity: Choose two other job roles and write down how you work with them. How do you help them, how do they help you. Eg: providing details of a new resident, keeping supplies up to date, preparing meals for workers and residents, keeping transport ready and available Discuss a few responses from the group. Aim is to generate understanding of the interrelationship and dependence across job roles and services.

Workbook page 10 Workbook page 10



Q: What does team work mean to you? Discuss responses These interactions (previous activity) contribute to team work. Identifying who you are working with, interacting and supporting is part of team work. Collaborating with each other makes life easier. Being able to rely on each other is important, and generally a valued part of a ‘great place to work’.

Together Everyone Achieves More The aged care sector in the Northern Territory is made up of various stakeholders who represent employer (peak bodies, government departments, employees (unions, industry networks) and those who are being cared for as clients / residents (specialist services, government agencies and service providers). Q: What organisations / services are you aware of at present? Who are they? Where are they located? What do they contribute? Listen to responses from the group to identify their awareness of the industry. Briefly discuss their roles and contributions Leads to a look at the regulatory framework of the sector in next section.

Workbook page 11 Workbook page 11 Workbook page 11



11.00 Break – 15 minutes

11.15 Standards & Regulations

July 2013 – The Aged Care Act (Living Longer, Living Better) was adopted at National level of government (Federal). Included in the Act is the establishment of Australian Aged Care Quality Agency. Their responsibility :

Accredit residential care services

Conduct quality reviews of home care services

Register quality assessors (those completing the reviews)

Advise Government where services do not meet standards

Promote high quality care, innovation in management and continuous improvement among providers

Provide information, education and training to providers Q: What does the term provider mean? Discuss to confirm understanding that this is a term to refer to the organisations that are providing services direct or indirect to those in aged care need. For Home Care services, there is an established set of standards that have been developed jointly by the Australian Government and State and Territory Governments to establish common arrangements that help to simplify and streamline the way community care is delivered. The Standards of Accreditation establish what is expected of an aged care residential facility and the services that are provided. Services may be provided in a physical aged care home, or in the home of an aged person who needs assistance. We are going to explore the standards for residential facilities.

Workbook page 12 Show HACC standards HO – Accreditation Standards. Laminated version



Accreditation Standards 4 areas of focus:

1. Management systems, staffing and organisational development 2. Health and personal care – looking after the person’s health 3. Resident lifestyle – ensuring a level of control over daily living 4. Physical environment and safe systems – having a safe place for client, workers,

visitors (family, friends and suppliers or contractors) Activity: Provide each person (group) with a fully copy of the accreditation standards In pairs / small groups – review one of the standards. Discuss in group what you think this is about, what is the key message in 25 words or less. Use the flip chart (paper) provided. Present your key message to the larger group. You have 10 minutes (If space available, shift groups to flip chart easels, otherwise can be conducted at group tables) OR: Have each person read each of the standards and highlight key words that gain your attention. Review one standard at a time with the group. Purpose is to create awareness of the standards, and the four areas of coverage. Participants to demonstrate through group review what is broadly addressed in each of the standards. Summarise in

Flip chart / markers Highlighter per person



Interpretation of Standards might include: Standard 1 – Ensuring the organisation (provider) has integrity, is compliant and is genuinely committed to residents care. Not going to disappear as a business. Culture of the organisation is around care. Standard 2 – Looking after the health and well being of the residents. The medical / health care that is needed will be provided to professional standard. Standard 3 – Residents – living at home or at a home – will be involved in decisions about their lives, and encouraged to maintain their interests – social, spiritual, educational. Standard 4 – Everyone lives and works in a safe, secure place. Visitors will also be safe and secure. Complete the section on page 10 of the workbook to summarise the standards as you understand them based on these discussions. Discuss some responses. Allow 10 minutes group discussion, 10 minutes for presentation to group and 5 minutes to update workbook. Q: Why are these regulations important? Q: What would happen if not in place? Q: Which of the standard has the most impact on your job role?




To ensure that the standards are maintained, an audit (check) is completed by a qualified (trained) assessor (person). An audit will find any areas that need improvement, or any areas that are obviously breached (not working well or not in place). These audits are monitored by the AACQA. Australian Aged Care Quality Agency If a provider (aged care home or provider of services to a person’s home) is found to NOT meet the standards, they can risk losing their licence to operate.

Every employee should do what they can to avoid this happening. These standards are about the operation of a residential aged care service. What other legislation might / will apply to your workplace? Rules and guidelines more directly related to your employment, terms and conditions. List responses to include:

Discrimination


Bullying and Harassment

Fair Work Australia

Food Hygiene / HACCP

Industrial Relations – awards

Privacy act Will review some of these in later sessions



12.15 Lunch Break – 45 minutes

1.00 ‐ 1.15

Video Our afternoon sessions will look at manual handling and handling of people, as well as discussion on how the health care industry across the country has a shift to being service oriented and appreciating the importance of working together. Want to share with you a video to help us explore these ideas. Screen the first 10 minutes (10.26 end) there will be a short ‘black out’. Stop at this point. Discuss some reactions to the meerkats and their safety and team work message. Culture of interdependency / 100% alert 100% of the time / no short cuts / you are looking out for them, they are looking out for you / sharing the information you have / essence of safety is team work. This is to set the ‘tone’ of all the WHS messages ‐ caring for each other, teamwork, staying alert.

Slide 7 DVD ‐ Meerkats

1.15 Manual Handling Statement: “Manual handling is the most common cause of injuries for employees working in aged care facilities, accounting for 58 % of all injuries.” In the Northern Territory, the three main causes of injury which resulted in a workers compensation claim being lodged in the Health & Community Services Industry are:

Muscular stress (lifting, carrying objects, putting down objects)

Falls on the same level

Muscular stress (handling objects other than lifting carrying) Most commonly injured part of the body is the back followed by the shoulder, arm hand




and neck. Q: What is manual handling? Definition: Manual handling is the pushing, pulling lifting and lowering, moving holding or restraining of any person, object or animal. Q: What are some examples of manual handling tasks in your work area or job role?

Lifting people – which will be addressed in more detail in next section

Moving / making beds

Shifting equipment

Carrying equipment – buckets/boxes of supplies (food or other)

Pushing of trolleys / wheelchairs

Aiding transfer from bed to chair, bed to toilet,

Transfer in and out of vehicle

Cleaning activities – mopping

Laundry activities – on‐site or transfer of linen Ideally, aged care facilities would follow a “no lifting” policy where lifting is eliminated or minimised. However it is recognised that finances and other considerations may not make this possible. In this case other measures need to be taken to reduce injuries or near misses.

Workbook page 14 Slide 9 Flip Chart



This session will look at:

Five steps to safe manual handling – applicable for all situations

Considerations for handling of people

What to do if you have an incident / injury

SAFER model for manual handling

Five steps to safe manual handling: SAFER. S ee it A ssess it F ix it E valuate it R eview it As we review each step, make notes in your workbook on page 12 to remind you of what each step is about. See It: This is essential first step in process, where you identify risky manual handling tasks in your work place. Refer to initial list of activities. At an individual level, this is about looking at what you are about to do (eg: lift or shift a load/ person) and consider what risks are part of the task. At an organisation level this is about having a system or practice where your work area is regularly inspected for potential risks. Some organisations will conduct work place hazard inspections. This indicates that prevention is part of the plan, not reaction.




Assess It: Once the task or situation is identified the next step is to assess the risk to you and/or other workers. Q: What makes these (listed) activities risky?

Actions and movements – of others being unexpected.

Workspace layouts – is the layout contributing to risk? Are chairs available/ step stools / ladders. Am I sitting under an air vent? Do I sit straight at my workstation? Can I take breaks?

Postures ‐ am I lifting with knees or back? Will twisting / turning be involved? How can I adjust my seating?

Duration or frequency of the task/activity – how often is this done?

Location of load and distance to move – how far do I need to go?

Weight and forces involved – is there an obstruction? How heavy is the load?

Skills and experience – have I been trained to perform this task? Who can show me how to do this safely? Am I in personal good health to perform the task?

Equipment provided – suitable for the purpose? Easy to access? There is an ‘8 second rule’ that suggests if you need to take more than 8 seconds to locate the aide / solution then you will go ahead any way. What does this mean for work place design? Advice from grandmother: “A place for everything and everything in its place”. Particularly relevant to next step of ‘Fix It’. Need to have the tools / equipment / lifting aides accessible.

In an organisation this step will involve determining the likelihood of an injury occurring and the seriousness of the injury that may occur.



At and Individual level you might determine if you think that the load is too great, or if the chance of an injury is likely. If so, take appropriate action to reduce the risk. Might determine if some device will assist, or getting the help of another person. Fix It: This is about controlling the risk. Best way is to eliminate. Not always an option. Unlikely to be able to conduct the work without some form of manual handling. What happens when you take a short cut? Increases risk of the incident / injury occurring. In considering how to ‘fix it’, two forms of control: Engineering controls ‐ an engineering control is a measure that is physical in nature. Q: What could these be? Hoists, trolleys / doleys, foot pumps to raise beds, rails around beds…seek other examples. Administration controls – these are work methods or procedures that are designed to minimise exposure to a hazard. Training activities are an administrative control and might include training to use equipment or the appropriate strategies and steps for a specific task. E.g. transferring a resident in / out of a vehicle, bed, chair. Signs in the workplace to caution about risks, provide advice are an administrative control.



Q: What signs have you seen in workplaces (current or past) that place that relate to manual handling? Review signs and briefly discuss what messages are being communicated. Safety equipment is considered an administrative control This will involve the use of PPE – personal protective equipment. In this context may involve the use of back belts to prevent injury. Wearing closed toe non‐slip footwear might be considered to ensure grip when working with loads / people. Other equipment that might be used: rails around beds or chairs to help with balancing of a load or providing some stability to reduce sudden movements. Participating in training of new equipment or work practices is also part of administration controls. Next steps in managing manual handling risks are focussed on prevention. Avoiding a repeat incident. Evaluate and Review. Evaluate is to check the results of the action taken (use of equipment, redesign of a task, use of signs or other training activities) to see if it was successful. This can be done by reassessing the task or activity to identify if risks still exist or have been reduced. Review – after a period of time, appropriate to revisit the situation and see if it is better or worse or with no change.

Slide 11 Workbook 17



In summary the process of SAFER can be used to reduce / eliminate a risk that might be associated with manual handling tasks or other hazards in your work setting. We will consider again with our discussion on general Workplace Health & Safety. Activity: Divide into small groups and allocate a case study to each group. Review the case studies in workbook (as group) and discuss the manual handling risks that might be associated with each situation and identify some actions that could help to eliminate or reduce the risks. Have groups present their case studies and comments with larger group and discuss. Identify any additional risks or actions that are appropriate. Allow 10 minutes for group discussion and 5 minutes for presentation. Activity: Consider your job role. Identify two tasks or activities that involve manual handling. What are the risks and what actions might you take to control the risk. In addition to the SAFER model, there are some agreed principles for Safe Manual Handling:

Avoid lifting and carrying where possible – control by eliminating the risk

Plan the activity from start to finish – administrative control and possible engineering / redesign

Assess the load

Workbook page 15 Workbook 17 Workbook page 17



How to handle – use the best technique – bend at knees, do not twist, stand facing load.

Determine where you will end – place the load – is the pathway and final space clear?

Identify if a mechanical aid is needed / available or another person

Vary tasks – alternate heavy tasks with lighter tasks

Share the load – work in pairs for specific tasks and/or rotate the tasks.

Reduce loads if they can be broken down. Especially if lifting frequently or for prolonged periods.

Q: Reflecting on the Meerkats, what messages did they have that can be applied to “safe manual handling”? ….be alert to the problem…don’t take short cuts…work together….

Prevention is always better than cure.

Handling People Handling a person: The industry that you are a part of is centred on the care of people, many of whom are frail or in need of assistance to complete activities of daily living that we might take for granted.

Going to toilet, showering, moving from bed to chair, moving in or out of a vehicle, getting up from bed, sitting up in bed, dressing and undressing or taking a walk for exercise. These activities may require help to be completed.

People handling refers to any workplace activity where a person is physically moved, supported or restrained at a work place. Specifically, people handling refers to work place activities requiring the use of force

Workbook page 18 Slide 12 (first reveal)



exerted by a worker to hold, support, transfer (lift, lower, carry, push, pull, slide) or restrain a person at a work place. Q: What activities will you perform that involved handling people? Note responses on flip chart, which may include:

raising a person who is at ground level

assisting with toileting

bathing/showering a person

dressing/undressing a person

transferring a person from a bed into a chair or from a chair into a bed

assisting a person from a restricted space, such as a car or bus

repositioning a dependent person, such as in a bed or chair

moving or conveying a person from one location to another, for example, in a wheelchair

supporting/being ready to support a person/child, such as during rehabilitation or when the child climbs on playground equipment

rescuing or retrieving an injured or deceased person

restraining a person, for example, to prevent movement in a person with cognitive or behavioural problems.

Q: People handling is a hazardous manual task. Why?

Potential for uncertain movement, unexpected force.

Requirement to perform with awkward posture – bending over other people or at lower levels, twisted when settling a person into a car or manoeuvring into a shower.

Flip Chart Slide 12 (second reveal) Workbook page 18 Slide 13



Repetitive actions – toileting or shower people during peak periods. No worker should fully lift a person (other than a small infant) unaided. That is without assistance from, a mechanical aid or assistive device or another worker. With people handling, the health and safety of the person being handled needs to be considered as well as the workers involved in the task. Q: What factors exist in the workplace that either contribute to or modify the level of risk associated with people handling tasks? Some contributing risk factors to discuss:

Work area design – impact on posture if need to bend down to bathe person, or shower in confined space. Working solo rather than in pairs / teams. Clear access ways. Working on different levels

Workplace environment – Indoor / outdoor, kitchen, bathroom, space or confined

The handling procedure – the best way to perform the task. Different handling procedures result in different working postures, such as leaning, twisting and require different levels of muscular effort to perform an action.

Characteristics of the person, as a load and size. Ability to understand & communicate. Need to keep person at a distance due to equipment / attachments or behavioural patterns.

Characteristics of the care worker – training/skills and own level of competency, own physical build and agility. How tired a person is during shift / at time of activity to be performed.

Clothing and footwear – of both person and worker have potential impact. Clothing that is restrictive can increase, along with footwear that is unstable.

Flip chart then refer to workbook to update Slide 14 Workbook page 18



Accessories / jewellery may create hazard – getting caught in equipment or clothing, causing skin tears,

Work organisation – the way the work is organised and tasks allocated, number of people on a shift, duration of work without a break, working in isolation – caring for a person in their own home. Lack of consultation – for new practices or purchases – may result in lack of acceptance or engagement.

Use flip chart to record factors and note ideas or suggestions from the group. Some comments will lead back to manual handling in general, however try to focus on the activities involving people handling. Activity: If prevention is better than cure, what steps can you take to ensure you are in best possible shape to address these manual handling and people tasks? Ask participants to list their responses and then work around the last asking each participant to contribute one step

Avoid repetition of same tasks over lengthy time period

Rotate tasks that are repetitive or required exertion

Keep learning about the equipment around you

Break up the time – get around and some fresh air

Invest some time in personal exercises or other personal health practices

Maintain good diet

Maintain good sleeping patterns

Find time for holiday’s or recreational activities

ASK for help

You only have one back, one neck…and they need to last your entire life.

Workbook page 19 Slide 15



Take Personal Care.

Reporting Injuries & incidents

In the event of an injury through work related activities, you must report the incident to your manager. Q: Why? o need to get help; attend to an injury o need to be aware of what has happened, o need to find ways to fix the problem/prevent from happening again. Sometimes a situation might be a ‘near miss’ – an incident that did not lead to an apparent or evident injury, but had the potential. Q: Why should a near miss be reported? o If situation arose again, may cause another person an injury o An injury (strain / bruise) may develop o Situation could have been avoided if some condition / factor is changed. Organisations will have different practices for the reporting and recording of incidents and it is important that you identify what that practice is for your workplace. Q: Who should an incident be reported to ?

Immediate supervisor / team leader

HR person

Workplace Health / Safety officer

Flip Chart – “near miss” An incident that did not lead to an apparent or evident (obvious) injury but had the potential Workbook page 19



Advising an appropriate person as soon as possible means you have best options for getting any help – short term or long term. Writing down information about the incident / injury on an Incident Report. Will vary from across organisations, but generally require same type of information to be recorded. What details might be included in an incident / injury report? Collect responses on flip chart:

o time & date o who was involved o what happened o what action was taken o names of witnesses o what caused or may have contributed to the injury o part of body that is injured.

These details help you to get help. Be as accurate as possible. Refer to template in workbook page 28/29 for the purpose of identifying the type of details that might be noted. Every employee has an obligation to ensure that they complete their work in a manner that avoids creating risks, injuring self or others and generally behaving in a safe manner. Will explore in more detail, but for this purpose, important to remember:

Workbook page 19 Workbook page 28/29



If you have an injury or near miss – report it!

Slide 15 (reveal last line)

3.00pm Afternoon Break ‐ 15 minutes

3.15pm Customer Care

Recent changes have generated an increased focus on not just what service is provided, but how it is provided. Activity: Use a highlighter to identify how many times the word change (changes/changing) and the word support appears through the flyer. Q: What message do you think the government is trying to share in these (living longer, living better) flyers?

We will be less directive and more supportive

Making life easier

Choices are available

You are in control

Change is happening – things are going to be different. The Living Longer, Living Better policy is a clear example of the shift to a “quality of service” focus.

Handout ‐ Living Longer, Living Better Colored Highlighters/markers



Combined with changes to consumer expectations, the role of being a service provider has never been more important. The Past ‐ you aged, your health declined, you moved to a nursing home, you received what treatment you needed to survive to the end of a life. Today – you age, you plan, your health impacts on your capacity to live a certain way so you adjust, you make choices, you transition, you are cared for with a focus on health as well as lifestyle. This may or may not include home care or being a resident of an aged care facility. Whilst a simplistic view, the significance is the shift from being treated to being cared for – not just in health but also in wellbeing / lifestyle. These changes are what is being referred to as Consumer Directed Care Activity: Listen to this message and write down words or ideas that attract your attention. Video Clip: Changes for the Aged and Health Care Services 10 minutes Q: What words had meaning to you? Looking for:

o Understanding needs o Walk in the shoes of those you are caring for

Slide 16 Video Clip Workbook page 20



o Keeps people independent o Working in partnership o Respectful relationships o Empowering & Enablement o Making choices o Having flexibility

Q; What about the comments regarding impact on workers in the industry. What message did you get? o Need to be building respectful relationships o Gives us a lot more freedom to do a lot more with our clients o Doing things with people and not for people o Listening, promoting choice o Encouraging strengths and abilities Choices are being made based not only on what you do, but how you do it. Improving the services is not just about the facilities and funding, also about access to this information. For Australians, the website My Aged Care has been developed to allow easy access to information on how to get help, how to choose help and how to respond if a person is not happy with a service. This creates far more involvement from the cared person than previously available.




Working in this industry requires not only that you are good and what you do, but how you do it, and how you consider others in the performance of your duties. Not actually a new concept, but is getting increased attention.

In understanding this shift to a service approach, good to consider the Customer – Resident / Client / Patient. Q: What will they ‘look like’? What are the attributes / traits of your residents Note five / six responses on flip chart and then have participants add five more to each of their workbook lists. Ask them to aim for 10

Elderly

Senior – may be aged but still agile

Frail

Disabled

Range of health concerns – high to low need

Scared / concerned

Alone

Self funded retirees

Pensioners

confused

With family support or not

Worried

Non English Speaking Background

Slide 18 1st reveal Flip chart to start the list Workbook page 22 Complete list in workbook



Failing in cognitive ability

Discuss what individuals have added to their workbook lists Q: What do they want from you as carers? Again start ideas on flip chart and have participants continue listing in their workbooks aiming for 10

Respect

Confidentiality

Consideration

Attention – personal & medical

Compassion

Comfort

Time

Understanding

Skill / Knowledge

Confidence

Communication Q: Will these expectations change according to your job role? No, but might vary in time / attention and the range of skills and knowledge will vary subject to the aspect of care you are providing eg: transport, meals / nutrition, physical care, medical care. The items on the list (what do they want from you?) are within the scope of every job role. Attributes, behaviours that you can influence / deliver based on your attitude

Slide 18 2nd reveal Flip chart to start list Workbook page 22 Complete listing



towards your job. Activity: Q: How will you demonstrate these in your job role? What actions can you take to support a service approach in your work? Consider internal and external clients. Break down the list and assign 3 – 4 participants to a group and have them discuss what this might mean to them in the context of their job role / work place. Discuss responses with group.

Reliable attendance

Adjust speech patterns – slow down, don’t shout

Be patient

Ask questions to learn about the individual

Learn names and family members

Learn ‘favourite’ activities / books / topics of conversation

Respect privacy

Maintain dignity Discuss responses with group

You make the choice to make the difference.


4.15 Review and recap Covered today:



Our Industry – Story Nationally, Story for NT

Industry standards & accreditation

Manual Handling – safe practices for workers & residents and handling of people, plus importance of personal prevention.

Customer Care Q: What have you learned today that is new? Tomorrow we will look at:

Workplace health & safety – Emergency responses

Bullying / Harassment and other rules for work

Elder Abuse

Food Handling & Hygiene

Infection Control

Planning for your future Start time – 8.30am. Confirm location, access as needed.

4.30 Close Session


Aged Care Induction Workshop Day 2 – Session Plan


8.30

Welcome and Overview Welcome back. Overview of the day:

Additional Legislation – for your employment and well being

Workplace Health & Safety, Fire & Emergency

Elder abuse

Food Handling & Hygiene

Infection Control

Planning your pathways Housekeeping matters: Emergency Exits / Toilets / Smoking / Mobile Phones, attendance and breaks. Interact / Ask Questions / Have Fun! Review day 1. Using round robin or random robin questions to have participants share two things they learned in previous day’s session. Optional to write the responses on Flip Chart. Ask questions that will encourage them to expand on what they remember and how it relates to their job roles / workplaces.

Slide 20



9:00

Additional Compliance and Legislation 5 mins

Day 1, Identified Standards of Accreditation, 4 areas of focus that applies to the Aged Care Provider. What other legislation / laws / rules are part of the workplace? Review the list from previous day, which may have included:

Awards – outlines terms and conditions of your work

Bullying & Harassment

Anti‐Discrimination

Food Hygiene and Handling

Infectious Disease Control


Privacy acts Identify level of knowledge of each area of law/ compliance within the group. Invite individuals to explain the purpose of each. This session going to consider

Bullying and Harassment in the workplace

Privacy Act in relation to your workplaces and job roles.



The Girl & The Sailor 25 mins

Next activity is to generate discussion and thoughts around the diverse nature of our workforce and those we will be working with. Applicable for anyone, any industry. Introduced as an “activity to get the conversation of the day started”, without pre‐empting the purpose. Activity: Case Study – Sailor and the Girl. Refer to instructions page (facilitator guide) Learning: Working with people of different views / perspectives / background means you need to suspend personal judgements. Q: How are our attitudes formed?

Experiences

Cultural background

Education

Social comments Q: What does this mean for our workplaces? Working with and caring for people with different and very diverse backgrounds, beliefs and views. Important to allow these views / accept and perhaps learn. Tolerance and patience were key skills from discussion on day 1.

Handout & Flip Chart

9.30 – 10.15

Workplace Bullying & Harassment

On occasion we may find that someone in our workplace is behaving in a manner that is ‘not right’. In cases where that ‘not right’ is a result of being treated harshly, unfavourably or in an intimidating manner there may be some form of bullying /



harassment occurring. Q: What is “Bullying and Harassment”? Discuss some responses, caution on any personal stories being shared. The definition as applicable for a workplace setting. A worker is being bullied at work if:

An individual or group of individuals repeatedly behave unreasonably toward the worker, or a group of workers which the individual is a member and

The behaviour creates a risk to health and safety Repeated behaviour refers to the persistent nature of the behaviour and can refer to a range of behaviours over time. Unreasonable behaviour refers to behaviour that a reasonable person, having regard to the circumstances may see as unreasonable – this is an objective test. Q: What do you think might be considered unreasonable behaviour? Discuss interpretations of this. Bullying behaviour would be behaviour that is victimizing, humiliating, intimidating or threatening. Q: What might this look like?

Workbook page 23 Slide 21 Flip Chart Workbook page 23



o Abusing a person loudly, usually when others are present o Repeated threats of dismissal, or other severe punishment for no reason o Constant ridicule and “put down” o Leaving offensive messages on email or the telephone o Sabotaging a person’s work eg: deliberately withholding or supplying incorrect

information, hiding documents or equipment, not passing on messages and/or getting a person into trouble in other ways

o Maliciously excluding and isolating a person from workplace activities o Persistent and unjustified criticisms, often about petty irrelevant or insignificant

matters o Humiliating a person through gestured, sarcasm, criticism and insults, often in

front of management/others o Spreading gossip or false malicious rumours about a person with an intent to

cause the person harm. Not an exhaustive list, but provides an indication of the sort of thing to be aware of. What behaviour might be noticed in someone who is being subjected to bullying / harassment?

Reluctance to be/stay in certain areas

Reluctance to make eye contact / converse with some people

Poor attendance

‘Avoiding’ situations / making excuses

Decline in performance

Looking fearful, anxious, tense These behaviours might indicate that a person is being subject to bullying or harassing




actions of a workplace colleague. Important to identify the variation between “having a bad day” and identifying continued patterns of behaviour which might suggest some form of bullying or harassment is involved. Bullying and harassment generally has a pattern of behaviour, more than a single incident happening. Workplaces in general have a ‘zero tolerance’ for workplace bullying and harassment and will have a policy or code of practice that employees must take note of.

Identify when your workplace policy for bullying and harassment was issued / updated and what advice is given to help you and your co‐workers.

Employees must know what to do if they experience bullying or harassment, or if they observe / are aware of bullying or harassment taking place. Q; What would you do if you observed someone being bullied or harassed? Discuss: “What would the meerkat do”? Take action, be caring of individual and others, show concern, SPEAK UP! Important that behaviour is reported to an appropriate person. Might not be your immediate manager – if they are aware, involved. Definitely should be a HR person or someone in management role Confidentiality is very important in these matters.



Failing to take action may lead to legal proceedings. But more importantly will make the workplace a very unhappy place if not stopped.

Workplace Bullying is against the law. If you were being harassed of bullied, you would want someone to help.

Be part of the solution, Not part of the problem.

Slide 23

10.15 – 10.30

Privacy Act 15 mins

The world we live in relies heavily on the collection and sharing of information. For many people this creates concern as to how that information is collected, how and with whom it is shared and for what purpose. In Australia, we take our privacy seriously. There are laws that are intended to allow us to feel confident that personal and sensitive information is not misused or abused.

In Australia, privacy law generally relates to the protection of an individual’s personal

information. The Privacy Act (1988) includes thirteen Australian Privacy Principles (APPs). The APPs set out standards, rights and obligations for the handling, holding, accessing and correction of personal information (including sensitive information). Q: Why is this matter to be discussed at your induction? Working within this industry you are likely to have access to – directly or indirectly – to information that is personal and/or sensitive in nature.




Might include: o Medical records o Care plans o Family histories / connections o Addresses o Banking or financial details o Social security information

You have an obligation to ensure that your access is not abused. In simple terms, respect the access that you have to this information. List on whiteboard ‐ No gossiping, no colluding with third parties, no indiscrete conversations about your residents, no ridicule about what you might know. Your employer will have a specific policy on the management of personal information that is collected from your residents. Take the time to identify what that states and how it relates to you, directly or indirectly. Recall that we identified what your customers want from you? This included respect, confidentiality and compassion. This applies to this matter of access to personal and/or sensitive information. As with the video clip on CDC service, put yourself in the shoes of those you are caring for and consider how you would respond if your own personal details were misused.

Whiteboard Workbook page 24

10.30 ‐ Workplace Health & Employers have legal rights and responsibilities regarding workplace health and



11.00 Safety (the general overview)

safety. A duty of care exists to provide for the protection of the health, safety and welfare of workers and others within a workplace. An employers responsibility includes:

Provide a safe working environment (ensure that the workplace is safe, secure and will not present a risk to you whilst at work)

Provide safe systems of work (work practices that will not put you in harms way)

Provide safe plant and equipment (tools to do the job safely)

Provide information, training and supervision (to allow you to do your job safely and with access to appropriate assistance / help when needed)

In short, your employer has a legal obligation to ensure that whilst you are at work and performing your duties, all reasonable steps and systems are in place to avoid injury / damage to you, your co‐workers and others who might be visiting your workplace – family / friends, suppliers or contractors. To maintain their duty of care, employers are required to:

Monitor health & safety of employees

Address reported hazards

Develop WHS (workplace health & safety) and IM (injury management) policies and procedures

Consult with workers regarding WHS issues

Plan and implement WHS programmes, including training So, there is a duty of care, which identifies the responsibilities of employers, and there

Slide 24 Slide 25 Workbook page 25 Slide 26



are actions which allow employers to do something about those responsibilities. Q: What actions / processes do you know of in your workplace that relate to WHS care of employees and/or residents and visitors? Looking for: WHS representatives, WHS meetings, incident reporting, hazard inspections, signs, compensations / rehabilitation examples, light duties. Discuss examples in general terms and acknowledge as part of an employers “duty of care” in action. Most workplaces will have a “Workplace Health and Safety Management System” (WHSMS) of some form in place. This is likely to include: (list on flip chart and discuss)

Regular workplace inspections – checking to see that the work place is safe and free of hazards for everyone.

Having a WHS Representative ‐ someone you can discuss / talk with and raise concerns and solutions

Having a WHS committee – to consult with each department and with management team about safety, security matters

Training programmes – to advise and remind you of your own obligations as well as to understand how to perform your work in safe manner. Training might also be for the WHS persons to be part of the committee.

In return, Employers expect something from you as a worker:

Workbook page 25 Flip chart Slide 27 Workbook page 26



Workers have a duty to take reasonable care for their own health and safety and that they do not adversely affect the health and safety of other persons. Workers must comply with any reasonable instruction and cooperate with any reasonable policy or procedure relating to health and safety at the workplace. Video Meerkats – Step up to Safety 4.5 minutes Discuss – what does this mean to you? Q: What actions can/do you take to contribute to a safe & healthy working place?

‐ Keep (security) doors closed ‐ Lock cabinets – especially with medicines ‐ Check care plans ‐ Update care plans ‐ Use assistive devices / mechanical aids ‐ Report faulty equipment immediately ‐ Be alert to the work practices of others ‐ Be alert to the behaviour of others (as discussed with harassment /bullying) ‐ Keep access ways clear ‐ Use equipment, devices and tools in appropriate manner – follow instructions ‐ Be sensible about work practices – no risky behaviour that might endanger you

or others ‐ Speak up! Report items that need attention.

Slide 28 Video Workbook page 26

11.15 Morning break – 15 minutes

11.30 Incident Reporting In discussing matters of manual handling, discussed the item of reporting. Workbook page 26



Incident reports are a workplace document that record information that can be used to

o respond to an accident or near miss o identify preventative measures o contribute to any form of compensation actions

Review sample in workbook. Skim the sections / headings. Activity: Review the Incident at Sacred Heart” and complete the incident form provided. Can be done as individual or small group activity. Q: Were there any sections you found difficult to complete and why? When completing an incident form, important to be as accurate as possible. If you need help, ask for assistance. But remember, it will be your name that is noted and you should be willing to accept responsibility for the information provided. When you return to your work place, identify who is responsible for WHS matters in your immediate area and look for:

o Emergency Evacuation Plans o Warning signs in the workplace o Notices of WHS meetings o Toolbox activities / discussions o Incident reviews o Location of any incident registers o Location of any hazard inspection checklists

Workbook page 28/29 Workbook page 27 Work book page 28/29 Slide 29 Workbook page 30



Be proactive – find the challenge before it finds you.

Q: How?

o Participate in WHS meetings / consultations o Evaluate your work practices and be open to improvements o Evaluate the care you take of yourself – health/exercise o Report incidents/near misses with accuracy and timely o Take care of any equipment / aides – report damage or repairs.

Workbook page 30

12.00 Emergency Evacuations & Threats (20 mins)

Part of staying safe in any workplace is understanding what to do in the event of an emergency. Will consider this from two points

1. Responding when you are warned of an emergency situation 2. Responding when you find and emergency situation

An emergency situation, such as fire will require all employees to responds in a calm and controlled manner. Your workplace will have a system in place to advise you of any need to take action. Alarms or alert tones are used to let you know at what stage an emergency might be Different workplaces have different procedures for what you do in an emergency, but there are some elements that will be the same with the warning alarms. The meerkats communicate a possible emergency and have up to 20 sounds. Generally out workplace audible warning alarms have two tones.

Workbook page 31



An alert tone – BEEP, BEEP, BEEP will let you know that there is an emergency situation that needs to be investigated. There may also be an announcement over a public address (PA) system. Generally at this point, you ‘stand by’ for further instructions. There will be a team of people such as Fire Wardens, checking out what steps might be needed next. You may have some actions to take. Could be clearing any obstacles from pathway to an emergency exit – soiled linen, trolleys, beds, chairs. Collecting resident care plans. There will be instructions about assisting residents/ clients and visitors. Specific actions will be determined by your workplace plans. If an evacuation is required, the alarm will change to the Evacuation tone – WHOOP, WHOOP, WHOOP….increasing in volume. At this point you will be required to take appropriate steps to leave your workplace. Your specific actions in an emergency evacuation may be impacted by a few factors:

Your specific job role

The time of day – morning, evening, overnight

Your actual location in the workplace at the time of alarms e.g. kitchen, dining room, residents bedroom

Proximity to the emergency

Are you part of the emergency evacuation team? Evacuation of any premises will need you to be aware of where your Emergency Exits are located and where to go once you have exited the building.

Slide 30 1st audio Slide 30 2nd audio Slide 30 3rd reveal Workbook pages 32/33



Q: How will you know where to go?

Look for the ‘green exit’ signs

Know your emergency evacuation pathway

Know your emergency evacuation assembly area

Look for emergency wardens, and follow their instructions

If you are in a work area that is not your ‘regular’ area, make sure you know where the Exit signs are, and follow the signs until you are outside of the building. Q: Where are you going? To the designated emergency evacuation assembly point. Q; What will you do there? Wait for instructions from an emergency warden / team. Rule number one in any workplace emergency situation:

Stay Calm Your reactions and the ability to stay calm will impact on your residents who may be scared and unpredictable.

Do not shout, Do not run, Do not panic Very important that you are familiar with the emergency plans of your own

Slide 31



workplace. When you return to your workplace, locate your emergency evacuation plans and know your emergency evacuation assembly area. Most workplaces will conduct a ‘drill’, which is a ‘practice run’ of what to do in an emergency situation. These are a good way to identify gaps and ‘test’ peoples reactions.

Always participate in a drill as if it is a real situation. Your life and that of other may depend on your actions.

If you are the ‘first person’ to notice something that presents a threat to the safety of you and others, what should you do?

Always ensure that you are protecting your own life first. A standard practice is to follow the R.A.C.E. model

Rescue Alarm Contain Extinguish Rescue – remove others from harm IF SAFE TO DO SO. Do not put yourself at risk Alarm – Use break glass alarms or other devices / push buttons to raise the alarm Contain – close doors, windows to limit spread of fire Extinguish – if you know how to use the extinguisher, and located, use it.

Slide 32 Workbook page 31 Slide 33



Using Fire extinguisher – PASS Pull the pin, Aim at the base of fire, Squeeze the trigger, Sweep side to side

If there is a warden inter‐com point or WIP phone, you may use this to communicate with the respondent to the Fire Panel at your work place. WIP phones may be red or white. Never use this phone for any other purpose. Training on use of fire extinguishers should be a part of your workplace training. There are different extinguishers for different types of fire. TAKE note of the extinguishers in your workplace and immediate work area. As the emergency response team for your workplace arrive to help, follow their instructions until the Fire Brigade arrive. They will assume control and you must follow their instructions at all times.

12.20 – 1.00

Elder Abuse By very nature of our industry, you will be supporting those who are likely to be vulnerable. The issue of Elder Abuse must be considered and your obligations and the part you play should be understood. Q: What do you know about Elder Abuse? Elder abuse is a relatively recent term for a form of mistreatment that, in reality is just one part of a spectrum of violence that occurs when differences in power exist in

Workbook page 34



relationships between people. Where there is an imbalance of power in a relationship there is a risk of abuse occurring from the dominant person or persons. Note: For the purpose of this session, Elder Abuse is not considering self‐harm or crimes committed by person(s) unknown. Activity Watch this video Elder Abuse (2.5 minutes) Note – this was prepared to be inserted as part of a fundraiser, hence the final message. Q: What message did you get about about elder abuse? Our My Aged Care website provides the following definition from the World Health Organisation: (read from workbook) “...a single or repeated act, or lack of appropriate action occurring within any relationship where there is an expectation of trust which causes harm or distress to an older person.” In context of working in Aged Care sector, this session will explore

United Nations Principles

Types and signs of elder abuse

Risk factors

Slide 34 Internet Access Slide 35



Responding to elder abuse Addressing elder abuse is human rights based, by recognising that all adults have the right to self determination regardless of their age, eccentricity or life choices which others may not agree with. In 1991, United Nations adopted principles for older person “To add life to the years that have been added to life”. Review these principles in workbook. Activity Highlight ‘all adults have the right to self determination regardless of age” These principles were developed based on an appreciation of independence / participation / care / self‐fulfilment. Q: Why have these principles been developed? Discuss responses Research shows that potential for up to 8% of older people experience some form of elder abuse in any one year; however this may be the tip of the iceberg and impacted by factors such as location / culture. Q: What is the connection between these principles and our Accreditation Standards? Standard 3 addresses retention of personal, civic rights and retain active control of their own lives. Standard 4 requires that residents live in a safe environment.

Workbook page 35 Highlighter Accreditation Standards (laminated copy as reference)



Q: What does elder abuse look like? Initial thoughts tend to create images of physical abuse; however abuse may take other forms including:

o Physical – actual physical contact that is harmful o Psychological – threatening, intimidating, humiliating, scaring o Financial – control of money, withholding of money, taking through theft or

fraud o Social – imposed isolation, withholding access to people, friends or family,

ridiculing o Sexual – forced sexual activity up to and including rape o Neglect – failing intentionally or unintentionally to provide appropriate care.

Information on each of these forms is within the facilitator guide page. Briefly discuss what each one covers and what behaviours might be associated with each form. Q: What actions might be considered elder abuse?

o Deliberate and malicious act to remove a wheelchair and/or frame from reach. o Intimidation, threats to withhold items/actions o Shouting and / or name calling o Treating a resident like a child, ridicule o Creating a situation where sleep is not possible o Making fun of a residents beliefs, abilities or views

As workers in the sector, important to be able to recognise signs of abuse in your

Slide 37 Workbook 34 Workbook page 34 Workbook page 34



residents. Behaviours that may be noticed. o Withdrawn o Reluctance to be in a certain area or with a certain person o Crying o Un accountable fear or anxiety o Shaking, trembling o Cessation of regular social or personal care activities o Discussion or conversational references to suicide or ‘ending’ o Avoiding eye contact o Reluctance to be drawn into conversation o Change in eating or sleeping habits

It is important to be alert but also important to be careful about making assumptions. The evidence of one of these may be a sign of something else (change in medication, change in health, or change in circumstances), however it is necessary to remain alert to be able to determine what help might be needed. Q: What should you do if you observe actions of abuse, or notice signs of potential abuse? What would the meerkat do? Speak up and seek help.

In context of a residential care facility, a workplace policy will be in place and you need to be aware of the required procedures and take appropriate steps.

It is important that you do not ignore obvious signs of or observations of behaviours of your co‐workers, visitors or other people connected to the resident (victim).

Slide 38



In cases of suspected or identified elder abuse, there are some risk factors to consider. These are factors that may be contributing or impacting on the situation and the relationship between carer and the person being cared for.

Dependency

History of family conflict / dysfunction

Isolation

Physical health issues

Mental health issues

Impaired capacity

Carer stress

Addictions

Language and cultural barriers The actions taken will be impacted by the context of the resident’s situation – residential facility, living at home or in a community facility (?). Actions, referred to as interventions, vary in regard to the setting and the specific need. May include:

o Counselling services – external parties to confide and provide advice/options o Arranging respite care – where carer stress is contributing factor o Separating the victim from the situation – removing to new/different care o Finding alternative accommodation – crisis care or longer term o Taking legal action – reporting fraud, theft or serious physical abuse to

authorities Some things to consider:

Workbook 36 Workbook page 36



o The interests of the victim take precedence o Self determination is to be encouraged – to make their own decisions,

provided with all relevant options and given the option to refuse. o Assault and some forms of other abuse (theft and fraud) are criminal offences o Any intervention must be victim focussed with a view to ensuring safety and

on‐going protection from violence. Remember that the United Nations Principles for Older People have been designed to provide a philosophy to guide actions of people working with older people who are vulnerable to abuse whilst taking into account that individuals are responsible for their own behaviour. This is consistent with the Consumer Directed Care (CDC) model of involvement and empowerment in managing one’s own care. Ensure you know what the policy and procedure is at your workplace to prevent elder abuse. If you want to seek independent professional advice on what you see or think is happening, the following services are available by phone or email contact:

EAPU – Elder Abuse Protection Unit – 1300 651 192

Life Line – 13 11 14

Advocare – 08 9479 7566

Slide 39 Slide 40 Workbook page 36

1.00pm Lunch Break – 45 minutes

1.45 – 2.45


For a change of pace, you will be taking charge of the next activity.

For this activity



Activity 45mins Activity: Preparing a light meal for six Refer to notes regarding this activity and follow up with debrief and discussion on food handling and hygiene Timing is important to allow sufficient time for activity to be conducted and briefing to occur. Activity should be no more than 45 minutes including debrief discussion. Follow up session on Safe Food Handling practices should be 15 minutes

there is a kit of ingredients / tools and directions.

2.30 Safe Food Handling & Hygiene. Discussion 15 mins

People handling and preparing foods should take all reasonable precautions to make sure the food they are handling is safe and suitable to be consumed. Note – this is not just about preparing the food, but also the handling, which may be the activity of assisting with feeding or clearing away after meal, or noticing if food items have been left to ‘sit’ for a while. The food items may have been brought in to the resident from an outside source. If not stored / handled appropriately could create risk to resident or others. From the activity we have noted: Use of gloves – Critical for preparation of raw foods. Protecting the food, not the hands. Change or disposed of at any time that would involve ‘hand washing’ (after smoking, toilet, coughing, sneezing, touching hair, scalp or body, or if they are torn.

Slide 41 Slide 42 Workbook page 37



Use of gloves may be substituted for hand washing only if you are hand washing as required. Hand washing – wet hands with warm running water, add soap, rub all areas, dry thoroughly (recommend single use paper towel), use paper to turn off tap (if no auto device installed). Hand wash frequently; when you change foods, change tasks and as above. (refer to sample of hand washing guidelines in workbook) Cross Contamination Some foods should not be in contact with other foods. Raw foods should not be contacting with booked foods. Especially where blood or raw juices are present. Use different chopping boards to prevent cross contamination. Thoroughly wash and dry utensils after use with raw foods. Consider storage arrangements around cooked and raw food items – keep separate. Sanitizing – This is the process of applying heat or chemicals or a combination of both to reduce the number of micro‐organisms on a surface….to prevent spread and likelihood of infection. Cleaning with detergent is not sanitizing. Use appropriate sanitizing agents after / with regular cleaning of workspaces. Use of commercial washers may provide sanitizing if set correctly. But for benches and some equipment not use in washers, will need to apply sanitizer. Food Allergies – These are related to individuals and will be noted as part of care / dietary plans. In context of food preparation, important to read all product information. Errors can be very serious, resulting in severe reactions for some people for some types of food.




Common allergies – gluten, some seafood, eggs, nuts and nut products. Be aware of the risk where outside food items have been offered to other residents (or workers). Out of date / Spoiled food Soiled food generally relates to perishable items. Fruit and Vegetables items that are damaged, bruised or decaying should be disposed of. If not looking fresh, do not take the risk of leaving around for someone to eat. Once cut, consume promptly or dispose, unless suitable storage steps have been taken. Many products will have use by date and this should be observed at all times. Take your risks at home, not at work. Check expiry of products brought in that have been ‘lingering’. Food Storage Kitchen facilities will have established rules and practices. HACCP is a systems of food management that identifies “critical control points” and what actions to take at each point. This includes labelling and dating of prepared products, rotation of stored items(FIFO), cleaning of utensils and work practices of kitchen team members. Fridges and storerooms will be managed to ensure the right foods are stored in right locations, in the right containers and kept pest free at all times. Temperature controls There are temperature ranges for safe food storage – frozen, refrigerated, ‘stored’, cooked. This ‘zoning’ is around prevention of bacteria growth that may lead to food being infected to the point of presenting a risk to health. While this has most relevance for food preparation with the kitchen teams, you may be in situation of noticing food left idle, or the re‐heating of food, or “stocking” of food.

Workbook page37 Slide 44



General Food Health & Hygiene practices.

If a food handler has a contagious disease or is suffering from gastric symptoms, they should not be at work. This generally applies to all staff, but has potential for widespread contamination through food handling. Do not return to work until 48 hours after symptoms have passed.

Any sores, scratches or cuts must be covered with a waterproof bandage or dressing.

Cover coughs and sneezes with a tissue or your arm. Avoid using your hands and turn away from others and food if you cough or sneeze.

Dispose of any tissues immediately – place in bin, not pockets.

Clothing (including aprons, hats, shoes) should be maintained clean

Hair to be tied back and kept covered in kitchen areas

Don’t over handle food during preparation

Keep bins covered and use liners. Empty frequently at least per shift.

Workbook page 37

2.45 – 3.30

Infection Control Within the accreditation standards, the fourth standard addresses the matter of ‘physical environment and safe systems’. Included in this standard, is an expectation that “there is an effective infection control program” in place. The standard will focus on the management of an infection control program however in each job role there is a contribution to be made to ensure an infection free environment.

Workbook page 38



This session, will look at

What is an infection

How infections can spread

Precautions (care to be taken)

Some common infections Q: What is an Infection? An infection is a disease or illness caused when an organism inside a person multiplies to levels where it causes harm. When a person has an infectious condition, there is a risk that they may pass it on to another person. Stopping the spread of infection is called infection control The aim of infection control is to reduce the number of infections and to control or contain those infections which do occur. As we get older our bodies are less capable of fighting infection. Our immune system (natural defence for fighting infection) is more vulnerable. As many people come into aged care facilities with illness and/or poor health conditions, there is a risk to others and those that work and visit. Taking steps to prevent spread is important and smart. Sources of infection: A variety of organisms, (bugs) can cause infections.

Slide 45 Slide 46



Most common:

Bacteria Form of plant life – germs Only visible under a micro scope – cannot be seen by our eyes. Infections caused by bacteria can be treated with antibiotics

What sort of condition might be from bacteria? Sores, some skin conditions,

Viruses Smaller than bacteria – so cannot be seen by our eyes or a microscope Viruses need a body to live in and then will multiply…. Live in the cells of a living plant, animal or person Able to move and infect other cells Harder to treat and do not respond to antibiotics

Common Cold is most widely known virus condition. If not addressed, can develop into more serious – influenza, pleurisy, pneumonia

Some of these organisms are present and all around us and in normal numbers to not cause infection. For example, there are bacteria that live in the bowel and help with food digestion. Other organisms such as flu virus are highly contagious. This means they can spread very easily from one person to another. You do not have to be in contact with the virus for very long to catch it and get sick. Our immune system helps prevent infection; it is your natural defence against illness. However as we get older the immune system is less effective due to the ageing

Workbook page 38



process. Whilst providing aged care services, infections can occur in a number of ways. How can you or others be infected?

Bacteria, virus or other micro organisms can enter the body in the following ways: o Mucous membranes – nose, mouth, eyes, anus genitals o Nasal passages in the nose, and lungs during the act of breathing o Mouth into throat, stomach and digestive system o Skin puncture, by needle, insect bite, cut or graze.

Having entered the body, the nasty work of infection develops. Risk factors that aid the development of infection: (note these on flip chart and discuss briefly)

Contact with body fluids such as blood, tears, saliva, urine, faeces

Objects which have come into contact with viruses or disease – clothing, utensils of eating, handkerchiefs, tissues, …

Food & drink that has come into contact or developed unhealthy levels of bacteria due to poor storage

Flies or insect bites

Linens or clothes with body fluids

Residents, visitors or staff with infectious conditions such as colds or influenza

Poor personal hygiene of workers / carers

Medical conditions

Medical procedures

Slide 47 Workbook page 38 Flip Chart



Q: What activities might create a situation leading to exposure to an infection? Have these items listed on a flip chart and then provide the additional information to help ‘explain’ their impact on spread of infection

Personal care tasks

Food handling/service

Handling soiled linen

Being near people with infections Discuss each of these items in more detail: Personal Care Tasks: When performing personal care tasks – assisting with toilet, showering, feeding, transferring or travel – the care worker is in closer contact with older people and at risk of being exposed to body fluids or other infectious material: o Assisting a resident who has the flu in a confined space while they are coughing o Changing bed lined of a resident who has infectious skin disease o Assisting to wipe after toileting o Assisting to move from one location to another o Personal washing during shower / bathing Food Handling: As identified in previous activity, food and food preparation present opportunities for infection to spread. This may be due to poor storage practices, or poor preparation leading to cross contamination. Poor use of PPE such as gloves, hair nets or aprons can increase risk of infection




spread, especially if the care worker is the ‘carrier’. Some steps to follow o Wash your hands correctly o If you have a cut, it needs to be covered appropriately o If you are handling food that is not going to be cooked, you need to wear gloves o If you have a cold, you should not be handling / preparing food o Use clean / sanitized utensils / work spaces o Store foods at correct temperatures Handling soiled linen: Linen from beds, bathrooms and clothing can be infectious. Every piece of linen and clothing that you handle should be treated as infectious.

When changing linens : o Place directly in a linen skip – and skip should be as close as practical to initial

location o Linen that is infectious should be in specially marked skip and laundered

appropriately o Hold soiled linen away from body o Do not put soiled linen on floor o Do not shake linen when making beds – this can spread micro‐organisms

Being near people with infections: Simply being in close proximity of people with infectious disease increases your risk.

o If appropriate, use a mask or other PPE such as gloves, aprons or gowns. o When coughing or sneezing, always cover your mouth and use tissue or other

measure. Encourage this in those you care for, making them accessible (within



reach). o Change PPE before attending to other residents

Infection Control Q: What steps do you currently take to prevent / manage / control infection? Discuss responses and update workbook

Hand washing

Sanitizing

Antibiotics & other medications

Isolation of individuals

Use of PPE – personal protective equipment

Avoid sharing personal items

Hand washing is identified as the most effective way to protect spread of infection. Everyone has germs. Our bodies are covered with germs that help us stay healthy. In addition to the germs that are usually present on our skin, we also pick up germs from contact with other people and in our surroundings. Although people usually think that germs are spread through the air, the fact is that germs are most easily spread through hand contact. One of the best ways to stop the spread of germs or other infections is to wash or decontaminate your hands.




Hand washing needs to be EFFECTIVE. Review guide in workbook Q: When should you wash your hands? List response on flip chart and student workbook Looking for:

o When hands are visibly dirty o Before you eat o Before you prepare food items o After touching raw meats o After contact with any body fluids like blood, urine or vomit o After changing infant or adult nappies o After touching animals or pets o After blowing nose or sneezing o After going to the toilet

Q: What do we sanitize? Workspaces, hands or other parts of body, equipment (tools, devices especially in kitchens) telephones, headsets / handsets, beds, food trays/trolleys Q: What PPE might help control spread of infection? Gloves, masks, aprons, uniforms (where not taken home), soft shoes, gowns. As noted, many of our residents are likely to be vulnerable and at risk of being

Flip chart & Workbook 40 Workbook 40



infected as our immune systems decline with age. Some common infections in aged care

o Influenza (‘flu’) – spread by droplet and contact. Causes runny nose, aches and pains, fever, tiredness.

o Norovirus, rotavirus (‘gastro’) – spread by droplet and contact. Cause diarrhoea and/or vomiting

o Skin Infection (scabies, impetigo) – spread by contact. Causes rashes, redness, swelling, boils

o Tuberculosis (TB) – spread by airborne. Causes bad cough, sweating, fatigue, fever.

o Multi‐Resistant Organism – type of infectious agent that has become resistant to a number of different anti‐biotics normally used in its treatment.

These infections are well known to aged care workers and specific policies will be in place to help you manage them. Discuss this with your supervisor / team leader or WHS representative. Discuss this with your supervisor so that you are fully aware of the correct steps to provide assistance. As with workplace safety, vigilance is important. Taking short cuts or being careless will only place you and others at risk of prolonged discomfort of worse. So take the precautions needed and take care of your own personal health.

If you are unwell – stay away.

Slide 49 Slide 50 1st reveal Slide 50 2nd reveal

3.15 pm Afternoon Break ‐ 15 minutes

3.30 – Career Paths and Where to from here?



4.15 Development Note: In setting up for this session, have the list of job roles from day one on display. This workshop is specifically intended to assist you in ‘fitting in’ to the job role and the industry that you have chosen to join. We appreciate that you have chosen to be part of the solution to the challenge of having a skilled workforce for the Aged Care industry in the NT and trust that the information you have gained is of direct and immediate benefit. At session on day one we identified some of the diverse roles that the aged care and community health services sector has to offer. Encourage you to consider your current job role as a step within a career path that may lead to one of these roles, be it a parallel shift of an upward progression. Video Clip – We can’t do it without you. As with the provision of services and advice to those you are caring for, there are individuals and organisations that are open to discussing your career ideas and plans. For some of you there will be a HR team within your employer services and there may be a structured form of performance planning. This should be the ideal time to discuss your interest in taking up new skills, either through a structured training programme such as Certificate III (…), Certificate IV…

Workbook page 41/42 Slide 52 Video Clip



For many of the areas that we have discussed it is possible to participate in targeted training activities or workshops e.g. infection control, safe manual handling, elder abuse prevention and response. If you have the interest and inclination encourage you to explore these options. Might be a conversation with your employer as part of their policy for skills‐development, or might be something you take up for own personal professional development. Some contacts and links for assistance in developing a career plan: HSTAC Human Services Training Advisory Council, NT

www.hstac.org.au

Community Services & Health Industry Skills Council

www.cshisc.com.au

Australian Apprentice & Traineeships Care Careers Australia

www.aatinfo.com.au www.carecareers.com.au

4.30 – 5.00

Review and End Covered:

The aged care industry – the challenge and the demand

Accreditation standards

Manual handling and people handling – a safe model of workplace practice

Customer Care

Workplace health & safety – obligations, reporting and evacuations

Bullying / Harassment and the Privacy Act

Elder Abuse





Infection Control

Planning for your future Have participants complete reflection section in their work. Use random robin to have each person share an item they have learned from the workshop. What did you learn from the Meerkats?

Quiz Final request to complete the evaluation form before leaving. Providing us with feedback on this as a pilot project and want your views and input. Thank participants for attendance. Provide contact details for HSTAC / other for additional advice on planning or the content of induction. Encourage completion of evaluation form. This is anonymous.

Remember the meerkats!

5.00pm CLOSE

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