Home Support/ECP/Falls Prevention

Home support services

Older peoples living arrangements reflect changes to the family structure with an increasing number of older adults who live alone, for example in some European countries over 40% of women aged 65 years and over live alone 1. Even in countries with a strong tradition of parents living with their adult children, such as Japan, there has been significant change over the last 5 decades1.
Services to support older people to remain at home are important from an economic and quality of life perspective. It is much more cost effective to support a person to remain at home than support them in a residential aged care service2.

In Australia home support services are offered through government organisations, private for-profit and not-for profit organisations, voluntary or community organisations and informal or family carers. The 2012 Aged Care Workforce Report indicates that 149,801 people were employed in the community aged care workforce; with 93,359 in direct care roles of which 76,046 were employed as community or home care workers3. It is anticipated that the number will continue to grow as the ageing population increases.

The role of Home Support Worker is to assist the client in a range of activities as outlined in their action plan and assist in the evaluation of the client’s progress by maintaining accurate records and communicating with the Care Coordinator. The activities they assist the client with can include personal care, household duties, participation in community and general maintenance of health and wellbeing. It is important to note that there are clear lines of responsibility. In the film there were 2 points were the Home Support Worker’s scope of practice was clearly delineated:

• Reporting the food spillage and burn on Mr Rosa’s arm.
• Mr Rosa’s injured arm after his fall.

In both cases it was beyond her scope of practice to manage the injury, instead she contacted the Care Coordinator who was responsible for making the clinical decision as to what action should be taken. The Care Coordinator then took account of Mr Rosa’s full medical history to determine follow-up interventions such as an appointment with the Dietician to check his nutrition and organising the Extended Care Paramedic to assess his injuries after the fall.

Home Support Workers play a vitally import role in enabling older people maintain their quality of life and in some cases can become very important people in the life of the older person.

 

Extended Care Paramedics

Extended Care Paramedics work collaboratively with other health professions to manage and treat people in their place of residence including their home or residential care site4. The service assists in reducing the number of people admitted to hospital or attending Emergency Departments4.

 

Falls and falls prevention

Falls are the leading cause of injury in older people and a significant factor in the potential loss of independence5. When working with older people it is important to be proactive in reducing falls. Clinical guidelines on preventing falls in older people recommend health professionals routinely ask the person if they have fallen in the past year6. The Health Quality & Safety Commission of New Zealand have developed 10 TOPICS on reducing harm from falls and suggest the 3 questions in the table below to quickly screen for the risk of falls.

 

Issue	Question to ask
Having fallen previously is predictive of falling again.	Have you slipped, tripped or fallen in the last year?
Balance problems and lower-limb weakness increase the risk of falling.	Can you get out of a chair without using your hands?
A fear of falling can cause unnecessary restriction of activity, loss of function and diminish quality of life	Are there some activities you’ve stopped doing because you are afraid you might lose your balance? Do you worry about falling?

 

Health Quality & Safety Commission of New Zealand, 20014

 

Reflection

Before viewing the next film reflect on this film clip and consider the range of people already involved in supporting Mr Rosa and how important it is that they maintain effective communication with each other to provide services.

• What were the key events or points in the film when effective communication was essential?
• Do you think there are any aspects in relation to Mr Rosa’s situation that have not been addressed? If yes, how would you address them?
• What knowledge and skills do you need to further develop to be able to work with older people in the community?

 

 

 

 

 

References

1. National Institute on Aging. Why population aging matters. A global perspective. 2007 [cited 2014 Sept 24]; Available from http://www.nia.nih.gov/sites/default/files/WPAM.pdf
2. McIntosh G, Phillips J. ‘Caring for the Elderly’ – an overview of aged care support and service in Australia. Parliament of Australia e-brief. 2003 [cited 2014 Sept 24] Available from http://www.aph.gov.au/About_Parliament/Parliamentary_Departments/Parliamentary_Library/Publications_Archive/archive/agedcare
3. King D, Mavromaras K, Wei Z, et al. The Aged Care Workforce, 2012. Canberra: Australian Government Department of Health and Ageing.
4. SA Ambulance. SA Ambulance Service fact sheet: Extended care paramedics. [cited 2014 Sept 24] Available from http://www.saambulance.com.au/LinkClick.aspx?fileticket=7dKFTy8RTL0%3d&tabid=82
5. Rubenstein LZ. Falls in older people: epidemiology, risk factors and strategies for prevention. Age and Ageing. 2006; 35-S2:ii37-ii47.
6. National Institute for health and Care Excellence. Falls: assessment and prevention of falls in older people. 2013 [cited 2014 Sept 24] Available from https://www.nice.org.uk/guidance/cg161