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Direct Care Roles and Responsibilities: How to be the Best Worker for the Member with TBI
Successful completion of this training meets one hour of the four hour annual training requirement for Personal Attendant Services direct care staff as provided through the WV TBI
Waiver Program
• Information included in this presentation was current at the time it was developed
• Presentation materials are reviewed on an annual basis
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Disclaimer
Melodee A Hursey, MSW, LSW, CBISTAPS Healthcare, Inc.TBI Waiver Program Provider Educator
Ms Hursey is a Certified Brain Injury Specialist Trainer through the Academy of Certified Brain Injury Specialists and a West Virginia Licensed Social Worker. She has more than 17 years of brain injury experience in a variety of areas including rehabilitation, waiver, support group facilitation, training, and program development.
Contact information:
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Author
Upon completion of this training participant will be able to:
• Identify three responsibilities of a direct care staff
• Describe two principles of direct care• Identify five rules for maintaining
boundaries with members• List three tips direct care employees
should remember to stay safe
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Learning Objectives
Traumatic Brain Injury (TBI) is an insult to the brain not of a degenerative or congenital nature caused by an external physical force, that may produce a diminished or altered
state of consciousness resulting in an impairment of cognitive abilities or physical functioning. It
can also result in the disturbance of behavioral or emotional functioning, may be temporary or
permanent and cause partial or total functional disability or psychosocial maladjustment.
National Head Injury Foundation(now the Brain Injury Association of America)
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Overview of Traumatic Brain Injury
• A non-degenerative, non-congenital insult to the brain caused by an external physical force resulting in total or partial functional disability and/or psychosocial impairment
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Medicaid TBI Waiver definition
• Every 23 seconds, one person in the United States sustains a traumatic brain injury
• Each year, an estimated 1.7 million people sustain a TBI
Centers for Disease Control and Prevention
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Overview of Traumatic Brain Injury
Watch the short videos below before continuing.
(Right click on each link and chose open Hyperlink)
Traumatic Brain Injury – Jerry’s Story
Traumatic Brain Injury – Josh’s Story
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Videos
• Provide long-term direct care and support services◦ To enable a member to remain at home rather than enter
a nursing facility
• Assist the member with ADLs (activities of daily living) and IADLs (instrumental activities of daily living) ◦ To help the member to remain in the home
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What is the Role/Responsibilities of a Direct Care Staff?
• Assist the member in community activities o To help them develop and maintain social relationships
• Assist the member with environmental tasks and errands o That are essential for the member to remain in the home
• Be compassionate, patient, and tolerant
• Report significant changes in member’s condition, any incidents, or environmental hazards
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Roles/Responsibilities (cont’d)
Personal Attendant Service agency staff cannot perform
any service that is considered to be a
professional skilled service or any service that is not on the
Member's Service Plan or Spending Plan
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What You Cannot Do
• Care or change of sterile dressings • Colostomy irrigation• Gastric lavage or gavage • Care of tracheostomy tube • Suctioning• Vaginal irrigation • Give injections, including insulin • Administer any medications, prescribed or over-the-
counter • Perform catheterizations, apply external (condom type)
catheter• Tube feedings of any kind • Make judgments or give advice on medical or nursing
questions • Application of heat
From page 31 of the WV Traumatic Brain Injury Waiver Program Manual
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What You Cannot Do
• Independence: o Freedom to direct one’s life, able to do things
for oneself when possible• Choice:
o Each person chooses what to do and when to do it; caregivers don’t tell them what to do
• Dignity and Respect: o Each individual is a person, each person needs
respect, privacy and treated the way he or she wants to be treated
o When a member needs assistance they still need to feel they are valued and in control
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Principles of Direct Care
• Person-centered approach: o Assistance or support is given when and how
the member needs it
• Participant-direction: o When possible, the member tells the caregiver
what to do, when to do it, and how to do it
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Principles of Direct Care
Before continuing to the next slides, please click the link to read the article
“How to Build Good Boundaries in Support Work”
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Building Good Boundaries
• Able to listen and understand• Good communication skills • Interested in working within the disability
field • Accepting of people with disability • Willing to collaborate and consult with
others • Able to accept and respect the choices of
other people • Respectful of different needs, values,
beliefs, culture The Arizona Direct Care Curriculum Project (2011).
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Qualities of a Direct Care Employee
• Committed to increasing independence and capability in others
• Able to share knowledge and skills but not to take over
• Maintains a positive attitude • Aware of realistic goals and limitations• Consistent and able to follow through • Professional – human, friendly, but not
needy or dependent
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Qualities of a Direct Care Employee
• Carry out responsibilities of the job the best way you can
• Maintain certifications and trainings• Be dependable and reliable• Maintain a high standard of personal
hygiene, health, and appearance• Show respect for the member’s privacy• Do not use the member’s things
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Professional Standards
• Recognize and respect the right of self-determination and lifestyle
• Keep your professional life separate from your personal life
• Control negative reactions to chronic disability or living conditions
• Maintain safe conditions in your work environment
• Do not bring your family or friends to the member’s home
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Professional Standards
• Limits that allow for safe connections between people
• A sense of personal identity and self that remains consistent over time
• The framework within which the worker-member relationship occurs
• Appropriate boundaries reduce risk of member exploitation or mistreatment
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Boundaries ~ What are they?
• Be clear about your role right from the beginningo You may be helping the member BUILD
friendships and relationships but you are not THE friendship
• Do not discuss your personal life with the member and/or family
• Do not borrow or loan money or items
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Boundaries
• Working in a member’s home can be very rewarding
• Working in a member’s home can be very lonely and scary too
• It is important that you protect yourself
• Know your resources and surroundings
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Protecting Yourself
• Be alert• Be observant• Trust your own instincts• Know how and when to call for help• Communicate with the member, family, and
team anything that you observe
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Safety Tips
• For more safety information click on this link to
safety tips for the direct care worker
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Safety Tips
• Many people come in and out of a member’s life
• You may be one of those people who decides to leave for any number of reasons
• Be open, honest, and upfront about this decision
• Allow the member to talk about their feelings
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Transitioning
• A person with TBI often has difficulty with change so there may be some anger and sadness ~ don’t take this personally
• Help with the transition to a new worker by providing good documentation and information
• Be positive and upbeat
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Transitioning
• Communicateo With the member, his/her family, the teamo Let the member know the plan. When are you
leaving? When will the new staff start?• Don’t overshare
o The member does not need to hear that you are leaving because you don’t like your employer or because you’re getting a divorce
• Stay member focusedo The service plan still must be followed
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Planning for Staff Transition
• If you’re the new person – o Allow the member time to adjusto Share basic information about yourselfo Ask the member to tell you what they need help
with - how they want you to be involved in their care And listen to the answers
o Read the member assessment and service plan Ask questions to get clarification
o Follow the service plano Talk to the team and familyo Be patient and nonjudgmental
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Planning for Staff Transition
Academy of Certified Brain Injury Specialists (2007). The essential brain injury guide. Edition 4.0
Acquired Brain Injury Outreach Service (2011). How to build good boundaries in support work
The Arizona Direct Care Curriculum Project (2011). Principles of caregiving: Caregiving fundamentals (http://azdirectcare.org/Training--DCW_Curriculum.html)
Vick, J, Vanderlick, JA, & Merricks, T. (2004). Professional ethics: Boundaries in helping relationships
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References and Resources
You may want to explore additional resources to help you do your job better*
Here are just a few:
o brainline.orgo Brain Injury Association of Americao Centers for Disease Control and Prevention: TBIo National Directory of Brain Injury Serviceso National Resource Center for Traumatic Brain Injuryo TBI Services at Center for Excellence in Disabiliti
es 1-877-724-8244 [email protected]
o Brain Injury Alliance of West Virginia
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Additional Resources and Readings
* If you are seeking formal training please check with your employer to make sure the internet training provider has been approved by APS Healthcare before you take the training
• To receive your certificate of successful completion you must first pass the test and complete an online evaluation
• A score of 80% or higher is required
• Once you have successfully completed this training module you will receive an email with your certificate of completion
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Next Steps
• Please scroll down and take the test below.
• Your thoughts and comments are very important to us. You may submit your comments here: TBI Training Survey
Thank You!
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Thank You for Your Thoughts
