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Quality of Life Care : Not Mindercare

Making life good in the community

Implementing person-centred active support in a group home for people with profound intellectual disabilities: Issues for house supervisors and their managers

Tim Clement, Christine Bigby, La Trobe University

School of Social Work and Social Policy

September 2008

Extracts from the La Trobe report (Link) on the transition of Kew Cottages Institution residents to group homes in the community, in 2008.  These extracts show questionable activities which remain, to this day (2015), as a direct result of the failure of all levels of Department of Health and Human Services management to set, and ensure the setting of staff work value expectations which guarantee service outcomes consistently equal service intentions. 

  • Without clear guidance on aims and methods, it was possible for these employees to continue their old practices in the new setting and for new staff with no experience to develop ‘institutional’ practices . A new group home, equipped with all the paraphernalia for ‘ordinary’ living only provides opportunities for engagement, which can be used or ignored. (pgs 21/22).

  • Active support was not a topic on the transition training.  Staff were unwittingly encouraged to carry out tasks in a way that was incongruent with promoting high levels of resident engagement. This was related to a further aim of the training, which was articulated as ‘giving staff ownership of the house’. (pg 22).

  • The house opened without a critical mass of staff in the house who had the knowledge, skills, abilities or orientations to enable high levels of engagement. , Caring for the residents and keeping them ‘fit, clean, and comfortable’ was probably the ‘model of support’ that was dominant during this phase. (pg 22).

  • One of these issues was the very low levels of resident participation at the house, as the staff had relieved the residents of any responsibility for completing household tasks. Within Disability Accommodation Services this is known as the ‘hotel model’. The major consequence of this was that the five residents spent substantial periods in their own home disengaged. (pg 23).

  • The hotel model is a metaphor that is used to evoke an image of what services should not be like. A staff member cooks and serves the tea whilst another one is doing the laundry. (pg 24).

  • We do the best we can, one step at a time. First and foremost in the house the priority is client care. Recreation and other things come along. Client care is our priority. If there is spare time you can go for involvement. People should be fit, clean, and comfortable. The other things come after that. (pg 26)

  • The house supervisor is an important person in shaping the day-to-day work environment in a group home. The house supervisor marks out the job for direct support staff, provides guidance and coaching, and influences the ‘culture’ (pg 26)

  • Staff listed the following:

1.       Keep people comfortable.

2.       Keep people happy.

3.       Keep people clean.

4.       Keep people well-fed  (pgs 26/27

LISA Comment:  The good department managed group homes, and there are many around the state, are as a direct result of the good integrity of direct care staff including the house supervisor.  Not as the result of department management direction and support.

Residents should not have to say, “We are lucky to be in a good house!”  Department management direction and support should ensure there is but a ripple between houses where staff have job satisfaction and are able to consider the residents as their second family.

There are four factors to service provision in a group home, 1. Administration, 2. Domestic Duties, 3. Personal Care, 4. Quality of Life Care.  This is the generally practiced order of priority.  Whereas, this order should be turned on its head!

Most residents of group homes have little self-motivation and need support staff to consistently engage, interact and enhance their skills in contrast to the residents being left to look at four walls and/or wander aimlessly hour after hour.

All DHHS managed group homes throughout the State are decreed to be “Active Support” compliant.  This is not intended to mean that residents just be encouraged to do various tick-the-box domestic activities, but that they are consistently engaged with through various interactive activities.

DHHS Residential Services Practice Manual, 3rd Edition, Aug 2012

Preface: Promoting Positive Practice 

Person Centred  Active Support is the key

Page 5.

Person Centred Active Support (PCAS) is the required approach to supporting residents. The approach promotes levels of resident engagement in everyday activities at home and the local community. 

PCAS involves 5 organisational components:

          

• staff proactively planning opportunities with residents

• staff identifying their responsibilities and allocating time
   to support resident

  involvement in activities

• staff supporting participation in activities as required via:

-   verbal instructions

-   gesture or physical prompts

-   demonstration

-   other means favoured by residents.

• staff documenting resident involvement

• staff monitoring and reviewing opportunities
  provided on a regular basis.

4.4 Person Centred Active Support, page 1.

Person Centred Active Support (PCAS) is the required approach to supporting residents. PCAS is based on a premise that most people enjoy spending time participating in different tasks and activities as opposed to doing little, or nothing. The amount of time spent participating in social, personal, household, community and other pursuits is a quality-of-life measure. The role of staff is to enrich residents quality-of-life by using every available opportunity to encourage and support them to:

•    participate in household and community tasks and activities

•    make choices and decisions

•    establish and maintain relationships        

•    develop independence and skill levels.

What is the aim of Person Centred Active Support?

Extra 1:  Autism Explosion leaves the NDIS in
                Disorder –
 
The Australian_ July 28, 2015

Extra 2:  NDIS Board Shake-up

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