Dignity of Risk vs Duty of care .
Disclaimer – That these are my own lived experiences and
understanding from the research that I
do around the NDIS and health-related topics please be aware that it is
informational only and not to be used as a substitute for professional advice
or working with a Planner, Disability Advocacy service or talking to your
Medical and Allied Health team.
This is a post that I
have been putting off writing due to the fact that I have my own care team, and the political climate around
the NDIS at the moment it seems that everyone has an opinion on it but isn't listening
to the ones who have to deal with the amount of paperwork that getting a
package and working with providers can entail and I am not saying that every
provider is difficult like this but it can happen, this way due to the amount
of paperwork that is involved in running a business that serves people with an
NDIS package and this is where a duty of care is such a tricky thing due to
a number of factors the first being.
1. The client’s capacity
to make decisions for themselves and to understand that actions have consequences
and that these consequences sometimes aren’t positive consequences, but
actually hurt or harm other people including their support team.
2. The person might not
be able to make decisions for themselves and might need help in doing so and
this is where family and friends need to be involved in the person’s care. Including
supported decision-making, and this is to replace the restrictive practice that
is adult guardianship or before this is put into place having supported decision-making
where a person is paired with an independent person who can help them make the decisions
based on all the information required.
3. That the person needs
to be given the dignity to make and learn from their mistakes and in doing so let
people know that they are able to learn from them.
So let’s break it down what is the duty of care in a disability setting
it is basically the duty of an NDIS service provider to: Provide the care or support services that the
person or provider has promised to deliver and deliver this care in a timely
and appropriate manner. [i]
It is also a legal and moral responsibility for a service provider to protect
the person from reasonably foreseeable harm and harm to others due to the
person’s disability or mental health condition.
There are also other contexts where a duty of care might mean breaching
the client’s privacy and this is something that I explore in another blog post.
But simply put in plain English it is the responsibility of the service
providers to protect the client from foreseeable harm or harm to others caused
by the individual and this is something that is really important for a support
worker to be aware of but it’s not often the case but it is starting to get
better in this area. As often it will be the Support worker, not the client
that is to be believed in this area and this can be painful as it goes to the social
narrative that people with disabilities are to be pitted and aren’t capable of
making decisions for themselves and this at times couldn’t be further than the
truth.
However this Duty of care needs to be tempered with the dignity of risk,
so this is one that deserves it’s own post as well, but it is that people with disabilities
need to be given the dignity to make decisions for themselves and to have a say
in who supports or cares for them.
It is also something that empowers people with a disability to be able
to take risks and learn from these risk’s much as a person without a disability
is able to take risks and learn from them as well, however, this is where
things like supported decision making come into play as guardianship should be a
last resort. As it is a restrictive
practice and we see that it is easily abused as we saw in the case of Britney Spears
case however the laws in Australia are different and vary from state to state
but do have the risk of people with a disability being subjected to financial
abuse and the abuse of power from the person who has the power to be the person
Guardianship. [ii]
It is also something to note that these terms are two sides of the same
coin the ability to protect someone from harm and the being able to give them
the space needed to be able to grow and develop their skills to move out of a learned
helplessness situation and this is something that I have talked about and this
moves into the phrase capacity building.
Capacity building is exactly that building a person’s capacity to be
able to live a “normal,” life and this means a life that is comparable to their
nondisabled peers, but in the case of someone with complex needs, this might
mean accessing day services instead of going to work or to build there own micro
business and to develop a centred life.
These three things go to the core of the NDIS in having person-centred
care but I am seeing that providers are struggling with the person-centred care
due to undertrained staff and staff not being able to cope with disabilities
and abusing the clients instead of learning about their behaviour’s and working
with them instead of against them.
As it is a fundamental truth that supports organizations are running a business
so we see that they are needing to balance this with the support that they are
giving but there are things that they can do in practice in this area due to
the fact that they need to move to person-centred care.
A couple of basic things are :
Listening to the clients when they
request a particular support worker as the client might be embarrassed or made
to feel like a troublemaker when they try to resolve conflict with the support
worker as the support worker might not have the training required to support the
person, I have found in my personal experience that the best support workers
are the ones that have had to care for a family member or friend with a disability,
and this means that they are able to see thing’s that others don’t see.
So this would be having the dignity of risk in being able to choose a
support worker and choosing them based on the skills the support worker has as
well as being a good personality fit.
Having flexibility in scheduled times and not having punitive measures
in place for cancelling a shift when they are able to cancel at very short notice
and still claim the money, for supporting the person.
Having the accurate level of staffing for both in support staff and
office staff as the best support workers can be held back by company culture company culture comes from the top down so if
the staff are supported and have regular
clients they are able to build great relationships with the family and this
goes along way to being able to provide good supports to the person.
As the office staff are mostly responsible for providing communication to
the person and their family and friends of what they can offer and I have found
that despite repeated requests at times I have to push my own care teams office
to communicate with me as they aren’t used to a client dictating to a support organization
what times and people they want however this is actually how it should be due
to person centred practice, and I know that this office is trying to make
improvements but is held back by a lack of good company support.
I understand that having regular shifts works for everyone but to do
rosters 6 weeks in advance isn’t practical I feel in a disability setting, due
to the fact you don’t know if the client will need support that day or be sick
and in doing my homework for this talking to some managers in other industries
they did rosters only up to a month or two weeks because somethings can change
and this is where having casuals can help, but given that this is a very new
industry we see that people are having a hard time wrapping their head around
what is expected of them.
So I encourage you to put your own experience in the comments around what
your experiences are with the dignity of risk and having a support worker guide
you or lead a family member.
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