Community Living Trust Therapy Team

Jackie Napier & Liz English

Challenging the Boundaries 2012

Innovative Solutions

Who we areB

Community Living Trust Therapy Services

Jackie

Liz

L

TerminologyL

Patients: service users, clients, people we support, subjects, residents

Helpers: Support people, paid workers, volunteers, family members, friends, nurses

Leaders: therapists, educators, team leaders, managers, service co-ordinators

Patient dignityJ

Patients are not just loads. They don’t have handles. They come in different shapes and sizes. They have feelings. They need to be handled safely, with care and dignity.

Patient handling and quality of care are dependent on staff safety and competence.

Quote from Section 2 Why Moving and Handling Programmes are Needed June 2011 Draft.

Decision MakersJ

ClientsFamiliesOrganisationsPolicy –service providersAudits

Risks•Support person

•Client

Who is the client?J

Person referred Person's familyPaid support people – home and vocationalFriends or anyone else who assists transfers

Juggling PrioritiesSafetyIndependenceMaintaining ability to standDuty of careDignity of riskFamily/ethnic cultureDignityLevel of understandingRight to work in a safe environment. A home

becomes a work environment.Who makes the decision?

Behavioural IssuesL

CommunicationTiming

MotivationMedication

Natural rhythmsHitting, biting, head banging

Underlying issues for Behaviour

Ideas

PeterL

Peter is very frail and unable to transfer on his own

Lives in own home with family supportFamily do not want a hoist in the home Also has paid carer coming into his homeHe needs regular position changes

when the book don't work challenging the boundaries 2012

SamJ

• Not walking• Was using standing hoist to remove pants and

go to the toilet• No longer weight bearing effectively for

standing hoist. Relying on extensor tone.• Full hoist now required, however cannot get

pants down even in a hygiene sling• To use the full hoist requires clothing to be

managed on the bed, this now involves many transfers to use the toilet

when the book don't work challenging the boundaries 2012

Mary-JaneJ

Elderly woman with CPVery frail skin ‘tissue paper’Decreasing physical and cognitive abilityToo unsafe for standing hoist, has had falls

and staff want/need to use full hoistMary-Jane very distressed about change

when the book don't work challenging the boundaries 2012

JackL

18 year old man with C.P.Significant I.D. + P.D. – no reliable

communicationLoss of ROM in all jointsLow bone density “density of a 90 yr old”. #’s on

movement. Currently #R patella #L humerusHigh pressure risk – currently ulcer on sacrum

and gluteal creaseFrequent seizuresLives with his mother. Goes to several places for

respite care

when the book don't work challenging the boundaries 2012

BillL

Lives in residential serviceVaried level of ‘skill’ in the team“easy to lift”Refusal from team to use hoist and sling“hoist too hard, not enough space, takes too

long”Staff’s right to choose to do this?

when the book don't work challenging the boundaries 2012

RangiJ

• Mobile but occasionally falls• Once on floor difficult to get up• There is no hoist – and does not meet funding

criteria for one in the home

when the book don't work challenging the boundaries 2012

How do you?BTransfer from seat onto a prone wedge?

Assist a person into a swimming pool where there is no pool hoist?

Position someone in a

contoured seating system without lifting, bending and

twisting?

Is there more to consider about?......

Physical closeness “Therapeutic handling”Essentials of lifeDignity of riskFitness of support personGender considerationsCultural considerations

Solutions needed