The Welfare Guardianship Trust as a strategy to support people without capacity From Aged Care New Zealand Issue 02 2022 An important issue facing Aged Residential Care (ARC) institutions is the question of how to work with people who lack capacity to make decisions. Dr Mark Fletcher published an audit of ARC facilities in Auckland in 2018 that found that 65 percent of residents without capacity to consent to living in that facility, had proper evidence of having a legal authority in place. In the intervening years ARC facilities have put significant work in to addressing this problem but there is still more work to do. Alison Douglass summarises the legal framework that we have for making decisions for these people. The PPPR Act permits a person with capacity to appoint an Enduring Power of Attorney (EPOA) to make financial, health and welfare decisions should they later lose their capacity and it confers statutory jurisdiction on the Family Court to make substitute decisions concerning the welfare and property of people lacking capacity or to appoint a welfare guardian or property manager (a Deputy under the MCA) to make decisions on their behalf. Decisions for individuals who lack capacity are ideally made by an enduring power of attorney, a court appointed welfare guardian or guided by an advance directive. Douglass further discusses how Right 7(4) from the code of rights is used controversially for making decisions in the absence of any of the mechanisms above and the significant issues that are raised by that approach. A not uncommon scenario is that a person is admitted from the community acutely to hospital and is found to lack capacity. If they do not have an EPOA or a Welfare Guardian and have no family and friends willing to take on that role, clinicians wishing to transfer their care to residential care, are placed in a difficult position. The ideal option is to find someone willing to act as a Welfare Guardian but there are significant numbers of people who do not have any one willing to do this for them. A court order can be applied for to approve the initial decision of the Subject Person’s transfer to residential care, but that does nothing to allow for their ongoing care, and there can also be significant delays in getting such an order through the court. In the context of acute public hospital beds being in high demand there is anecdotally increasing reliance on Right 7(4). In the past this has been managed informally in some centres by the clinicians or courts being aware of suitable individuals who are willing to volunteer as a Welfare Guardian. This approach has proved to be inadequate to resolve the problem in Wellington. The Wellington Welfare Guardianship Trust is a charitable trust established to recruit, approve and train suitable volunteers to apply to be court appointed Welfare Guardians for people who are unable to make, or communicate decisions for themselves. Once appointed the Trust provides ongoing support of the volunteers. =The Trust consists of a Board who brings various fields of expertise and experience to ensure the Trust’s aims are met. The current Trustees have expertise in social work, general practice, family law practice, family court processes and health and disability issues. The Trust Co-ordinator receives requests for volunteers from a range of people including hospital social workers, lawyers, rest home managers and family members who live outside the local area or are unable/unwilling to act as a Welfare Guardian themselves. Most requests for the appointment of a volunteer Welfare Guardian occurs when the Subject Person has no known relatives, when their relatives live in another part of New Zealand or overseas or when the person’s family cannot agree on which of them should be appointed. The co-ordinator matches the needs of the subject person to a suitable volunteer and the Trust then supports the volunteer to apply to the Court for an Order appointing them the Welfare Guardian. Once appointed by the Family Court the Welfare Guardian is the only person legally able to make decisions about the day-to-day care and welfare of their Subject Person, subject to the limitation on their powers prescribed by law. These may include decisions about non-urgent medical treatments and accommodation. The court orders may be tailored to specify what kind of care and welfare decisions the welfare guardian makes as the appointed decision maker for the subject person. The trustees meet monthly and as needed to interview prospective volunteers and provide support/education sessions for volunteers. We have a volunteer administrator. The major costs we face are the costs of preparing and submitting applications to the court on behalf of our volunteers to become Welfare Guardians. All the other work is done on a voluntary basis. We are currently unable to provide any Volunteer Welfare Guardian costs, such as travel costs. Welfare Guardians are appointed for three years so any volunteer needs to be prepared to take on this length of commitment, limiting the pool of people who may take on this length of commitment, limiting the pool of people who may be suitable. Each volunteer has a board member assigned to him or her as a first point of contact in case of any queries. We were established in 2015 modelled on the successful Otago Welfare Guardianship Trust, which has been operating since 2011. We appointed our first Volunteer Welfare Guardians in April 2018. Otago developed the website welfareguardians.nz that has the public site providing information about the function of the trust and importantly the confidential site which enables the storage of all the relevant documents and the recording of details of visits to Subject Persons by Volunteers. This has been designed so that future regional Trusts can be added to the site easily. In addition to Otago and Wellington other trusts have been established in Canterbury/West Coast Waikato and Whanganui, and the Wellington Trust supports volunteers in the Wairarapa. We had our first national meeting in July. The work of trusts to meet the need of people who lack capacity having no person able to be their Welfare Guardian can only ever be a stop gap. Clearly, there is no national coverage of public body that fulfils this role. Even within our region, our volunteers live too far away from some of the subject persons for it to be viable for them to offer assistance. There is no obligation to provide a volunteer. There may also be situations where the Trust cannot offer a volunteer to match the request for a welfare guardian or, in some situations, not wishing to expose a volunteer to a family in conflict. With increasing population and language diversity there will be more people who as they age either lose their fluency in English or were not fluent in the first place, thereby compromising their ability to communicate and to have culturally appropriate support through a welfare guardian. With age baby boomers the small pot of volunteer welfare guardians will be a growing problem for the elderly. It is also a significant issue for people with intellectual disabilities who have been cared for solely by their parents who may well die before their children. Parents may face cognitive impairments themselves and difficulties in fulfilling the guardian role for their adult children. The current arrangements are not satisfactory. We are hopeful that the law will be attended to address this in the near future. The law commission is current doing a report He Arotake I te True mō ngā Huarahi Whakatu a ng Pakeke Review of Adult Decision-Making Capacity Law, and is consulting widely on the issue. Anyone interested in making submissions can contact them at huarahi-whakatau.lawcom.govt.nz Author: Dr Ben Gray Chair Wellington Welfare Guardianship Trust. Wellington Ref: Aged Care NZ Issue 2 2022 Travel Easy The way in which we travel by foot, wheels or air in our later years may take a little more consideration. Let’s investigate the impact of our choices. The consideration given to getting around later in life might need to expand locally and even internationally. Perhaps it’s not only age that can motivate a change of route – many of us are now considering the environmental impact of our travel choices too. Locally Get walking! Move it or lose it! If you are retired, you’ll hopefully have more time to get to places. Yes you could drive to the local supermarket for that loaf of bread, but what if you pop on some headphones, and get the blood pumping with a walk there instead? If you can’t drive anymore, consider going electric. Electric scooters can go up to around 17 km/hr and include a nice big basket on the front and a decent sized pack on the back. They’re also easy on the environment. Electric bicycles have gained huge popularity amongst the older generation – providing an opportunity to combine transport with an inclusive level of exercise that suit so many types of bodies. Companies such as Driving Miss Daisy offer wonderfully helpful services and can take you to appointments, shopping trips, scenic drives and airport transfers. Perhaps you’ll give up driving as much when you hit 65 and are rewarded with a Gold Card which gives you access to free or reduced-price public transport. It’s enticing to not have to factor in where to park and the cost of petrol plus you might enjoy the added benefit of meeting a nice like-minded soul to chat to during the journey! Nationally If you’d like to see a bit more of this gorgeous nation we reside in, consider a bus tour. Often these tours cater to the over 65 market and make it easy going. Many tour companies offer guided tours specifically designed for seniors. They set the timetable, with activities, and places to stop and eat, and they organise accommodation all with a very comfortable spacious bus to get you from A to B. There is also the option of self-driving. Rent a campervan to explore New Zealand’s scenic landscapes and attractions. Don’t forget to inquire about whether they offer senior discounts. The NZTA provides information on driver licensing requirements for seniors. Cruise around the land of the long white cloud via ship! Our scenic waterways and coastline make a popular destination for cruises. The top cruise line companies offer special services and amenities depending on your age and abilities. Internationally There is more than just cruises on the menu that can suit a more mature audience’s appetite for adventure. Take a flight from one of our nation’s international airports. Many airlines offer special services for elderly passengers, such as wheelchair assistance and priority boarding. Cruises speak for themselves with popularity amongst this age group! Aside from wheelchair-accessible cabins and medical facilities onboard, cruises are often tailormade with knowledge of the types of activities and destinations you’d love to comfortably travel to. As with nationally, consider using a travel agency to organise flights and transfers to indulge in a tour over land. Your travel agency will be able to recommend tours specifically designed for people just like you and take care of the boring admin of booking accommodation and knowing the best places to dine. What about the dreaded jetlag? With the world now re-open to the savvy traveller in us all, the practical aspect of jumping on a plane to somewhere fabulous also needs to be investigated. Who wants to arrive in Europe feeling sleep deprived and moody when there are ways to alleviate the effects? The best approach is using the Old Girl Guide’s motto: Be Prepared! Adjust your sleeping schedule ahead of time and begin to go to bed and wake up closer to your destination’s time zone in the days and weeks leading up to the trip. Avoid coffee and alcohol (save the drinkees to celebrate arrival at your destination) and choose to stay hydrated with water instead. Invest in some noise-cancelling head phones and get as much rest during the flight as possible, interspersed with occasional walks, if possible, up and down the aisles. The other option if you’re not opposed to extra assistance in pill form, is jet lag pills. Often these can be purchased from the airport or try your local chemist. Melatonin can also be very helpful if taken for several days once you’ve arrived – but please do check with your Dr before throwing back extra medications. Lastly, avoid heavy meals. An upset digestive system won’t do your time adjustment any favours. Get assurance with insurance Whatever the travel you choose, it’s important to obtain travel insurance that covers any medical emergencies or unexpected cancellations. Some insurance companies may have age restrictions or require additional medical information so it‘s recommended to shop around for the best policy. Organisation is key to success for any kind of traveling you intend to do – plan your trip in advance and consult with a travel agent or tour company to ensure a smooth and comfortable, stress free experience. Ref: Aged Advisor 2024 Why Free Play is Good In today’s western world we have been encouraged to think success in life is all about academic achievement and the only way to achieve this success is through providing our children with ‘academic enrichment’ games and services. These enrichment activities can start well before school age and tend to gain momentum as the child ages. This, the “stranger danger” phenomenon and our busy lifestyles have led to a decline in children and youngsters play time especially unstructured free play. Play is very important in the growth and development of all youngsters. It helps with their physical, emotional, social and intellectual development. In general terms, play come in two categories: unstructured (free play) or structured play. Both forms are important. Structured play is directed by an adult with a goal in mind. It helps children learn to follow rules and routines, and give opportunity for development of physical and social skills. Unstructured free play is not led by an adult and has no goal. It may move from activity to activity, and may involve other children and possibly adults. This type of play allows children to explore and develop the skills needed for negotiating life without feeling pressured or fearful of making mistakes. Most play involves some physical activity, either hand skills or larger body movements. Play allows the child to gain strength, coordination and control over their movements, as well as physical fitness. Free unstructured play helps children learn about society and their emotions, especially through imaginative role play, where they pretend to be an adult. This helps then understand the society they live in and how to relate to others. They gain skills such as turn taking, sharing, negotiating and managing conflict. Youngsters learn from their peers and they enjoy playing together. This is a great learning ground for acquiring communication skills. The better children can express and make themselves understood, the less anxious and frustrated they will be, and the more relaxed they will be about new experiences and challenges. The practice they gain from role playing helps them conquer their fears and develop the confidence to independently deal with new situations Free play helps youngsters gain a sense of who they are, their likes and dislikes, strengths and abilities, and to respect the differences, thoughts and feelings of others. They build on what they know and explore different experiences in imaginative ways, enhancing their thinking and problem solving skills and their ability to entertain themselves. Why is the lack of free play a problem? Over the past 20 to 30 years, in an attempt to ensure their children’s success, parents have filled their children’s weeks with organised activities so there is little time for creative imaginative free play. This may account for the rise in anxiety, depression and suicide experienced by a growing number of our young adults. Studies have linked feelings of anxiety and depression to perfectionism. Perfectionism often comes from highly critical parents who expect excellence, which may produce overly self-critical children. Some may have learned success must happen at any cost and become anxious to get the perfect marks at the expense of values such as honesty and integrity. This is believed to have contributed to the increase in cheating in our high schools and universities. Perfectionism reduces creativity and is not good for society. If we wish to reverse the trend of depression, anxiety and perfectionism among our youngsters, society and parents need to revisit their ideas on what success looks like, slow our pace of life down and let our children engage in a balance of structured enrichment activities and unstructured free play. http://pediatrics.aappublications.org/content/119/1/182 https://www.pentagonplay.co.uk/news-and-info/why-free-play-is-crucial-for-early-years-children https://www.verywellfamily.com/unstructured-play-2764971 Age well - Maintain your body with Exercises If we want to have a happy active life as we age we need to ensure our body is fit to last the distance. Here are a few exercises that can be done in the comfort of your home. These 10 easy exercises are planned to improve:
Begin slowly and keep practicing each day. Do not expect results for several weeks. 1. Chin Tucks Stand as erect as you can with your neck drawn back and chin tucked in, not up. Hold head correctly; do not tilt chin. Pull head back in line with your spine, keeping chin horizontal. See picture. Hold this position for 10 seconds, relax, breathe, and repeat 3 times. 2. Shoulders back Pull your shoulders back as if you had a piece of elastic pulling your shoulder blades together in the back. Hold that for 10 seconds and relax. Repeat 3 times, relaxing and breathing and holding the position. 3. Shoulder shrugs Bring your shoulders around in big circles, 3 times clockwise and 3 times anti-clockwise 4. Head rocks While lying down, gently rock your head from side to side 10 times. 5. Toe Ups Go up on your toes as high as you can, come back down. Do this 10 times, increasing each week by 5 times until you build up to 50. 6. Leg Lifts Stand up and gently swing your leg back and forth 10 times; then out to the side and back 10 times. 7. Quad Sets Tighten the muscles on top of the thigh as tightly as possible and hold. Pull 10 seconds, trying every second to pull even tighter. Relax 10 seconds. 8. Runner's stretch Standing with one foot behind the other, lunge forward bending front knee to stretch calf muscles in the back leg. Keep both heels flat. Hold for 10 seconds. Repeat with the other leg. 9. Hip Circles Stand in front of a mirror and make a big circle with your hip as if there were a clock around your feet. Trying not to move your shoulders, circle with your hips to one, two three, four, etc o’clock positions until you have made a full circle in a clockwise direction then repeat the movement in anti-clockwise direction. 10. Gluteal sets Pinch your buttocks together, hold 5 seconds, then relax. Repeat 10 times. If you are wanting advice on maintaining fitness as you age, our friendly Physiotherapist can help. Just contact Therapy Professionals Ltd:
Phone: 03 377 5280 Email: [email protected] From “Self balance hints for Older Persons” by Carole B Lewis Aspen Publishing Virtual Villages – The best of both worlds The term “virtual village” may be new to you, but the concept has really started to gain good traction internationally. For those wanting to know more, Nigel Matthews gives an insight into how it all works. For many New Zealanders the idea of what a retirement village offers sounds enticing, but the comfort, familiarity and security of remaining in your existing home can be hard to relinquish. Welcome to Virtual Villages – a concept that allows you to enjoy the services and care usually found within a retirement village while continuing to remain at home. Although the first virtual village was founded in Boston nearly twenty years ago, it’s taken ten years to reach Australasia and a further five years for a New Zealand not-for-profit organisation to trial it in Auckland (in 2018). However, one of the ‘Big 6’ village operators now plans to make it a reality across the country. Arvida Good Friends is an initiative to keep older New Zealanders supported and connected, while living in their own home. By eliminating the need for people to move into a village, Arvida’s intention is nurturing connections and independence for all their members. The system is Community Centres, private home help and rideshare transport. This allows members to have both independence and social connection. CEO, Bill MacDonald explains the concept as a solution for older people to live well wherever they are, especially the 80% of people over 65 who choose to stay in their homes. Although they already have 33 retirement communities across the country, McDonald believes Arvida Good Friends will fill a vital gap in the retirement sector. “In ten years’ time, I want the world to notice how well older New Zealanders live. And I hope it can be traced to Arvida’s commitment to transforming the ageing experience through person-centred care – what we call the Attitude of Living Well.” When summarising the key advantages, McDonald claims the framework will provide state-of-the-art facilities for their clients, offer intelligent technology alongside human service and serve members with affordable transport solutions. Based in Addington, the first Living Well Centre opened in April 2021. The facility brings together activities, classes, club meetings, a cafe, beauty salon, exercise centre, physiotherapy, allied health services and regular events. After the launch in Christchurch Arvida has plans to roll out centres across the country over the next five years. During their market testing phase, Arvida quickly identified control, transparency, reliability and consistency as fundamental problems in existing home care services. Hence, as they start their service, they are focusing on three components to combat these current issues. First, Arvida Good Friends is powered by Lookout technology. Australia has used this technology for the past few years in their Home Care Package, the National Disability Insurance Scheme and remote health monitoring by the government and private insurance companies. Seeing its success, Arvida has actively invested in the development of this app for New Zealand. Secondly, their focus on people centred care has driven Arvida to offer a unique subscription based membership model. This gives members the opportunity to have full control over what services they choose and when. Bill McDonald explains the technology is an important part of this service, as it enables transparency around care and costs, including for family members. Furthermore, it matches helpers to members receiving care at home, based on their needs and their personality. Finally, all staff will be inducted on the legal standards of home and community support care and taught Arvida’s Attitude of Living Well philosophy. Through an online qualification system, supportive clinical oversight and Lookout, they will ensure Arvida Good Friends helpers will provide service of the highest standards. Bill McDonald believes these practices will set Arvida Good Friends apart as a one-of-a-kind, positive and effective service for their members. He says, “Living Well is about having choices on how and where we live, being able to find the help we want when we need it and finding it easy to stay active and connected with friends, family and hobbies. Arvida is here to help older New Zealanders choose to live well, wherever they decide to live.” Ref: Aged Advisor 2021 Using Slide Sheets The principle behind the use of slide sheets is they slide on each other to reduce the load on the helpers. Slide sheets should not be used against bare skin.
Log Roll the person onto the slide sheet:
Rolling over:
Removing the slide sheets:
Up and down the bed:
Remember to keep your arms close to your sides and your shoulders down, your body should move as one with the slide sheet as you lunge backwards. Be careful not to put the slide sheets on the floor. Use of slide sheets should ideally be done with two carers, however if the client can help to some extent, you could get away with one carer. An alternative is the Wendy Lett system which is designed for one caregiver and it stays in position. |
AuthorShonagh O'Hagan Archives
November 2024
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