Resolve to challenge assumptions about independence

Without a doubt, the topic of how to support independence has seen the biggest volume of training enquiries for me in 2022 (I touched on this in my September 2022 blog). I attribute many of these enquiries to the post-Covid lockdown effect. So much freedom was removed by the lockdown measures, and care providers became so used to keeping people safe in bubbles (which often meant that independence had to be curtailed) – and many people needing support equally became accustomed to this – that it’s been a hard habit to break on all sides.

That’s not to say, however, that independence was fully supported by all care professionals before Covid. It’s always been a topic many providers have struggled with, and changing this mindset has long been a passion of mine. Truly supporting independence will always have elements of risk attached, and risk is scary, which is why it’s often very tricky to navigate for care professionals (and families, and for some people supported). My blog ‘Risk verses Reward’, published in 2013, was the first example of me really tackling the topic of risk aversion through my writing, and it remains relevant to this day.


Risk and independence through the lifespan

Fast forward to the end of 2022 and we are still needing to embed within our culture the understanding that to remove all risk and wrap older people in cotton wool doesn’t do them (or us) any good at all. We all need an element of risk in our lives, and this goes hand-in-hand with being as autonomous as possible, making risk intrinsically linked with independence. The reason it’s bad for those of us providing support is that we ultimately aren’t doing our best by the person, and that in itself has negative feelings, like guilt and failure, attached.

The psychology of supporting independence through the lifespan is really interesting. We encourage children to become more independent (that’s growing up after all), then from our 20’s through to our later life most people are largely autonomous unless they need support due to disability, illness or injury. However, as health issues creep in and people get older, we want to start removing their freedoms and doing more for them, thinking this is a kindness and the right thing to do. It can get to a point though where we care for them in an all-encompassing way rather than supporting them to do as much as they can in a side-by-side model.

We also have a tendency to label people with support needs when they want to express their desire for autonomy. A classic example of this is the concept and label of ‘challenging behaviour’ in people with dementia, a learning disability or any other cognitive impairment who express themselves in ways that those around them don’t understand or know how to support.

This year I’ve been contrasting how we think about this behaviour in adults verses how my 2-year-old behaves. He’s finding his way in the world and demonstrates his expressions of independence on a daily basis. He is supported in these rather than stifled not to have them, meaning that he is now able to dress himself with some of his outfit for the day, attempt to wash and dry himself when he showers, and feeds himself almost entirely independently.

Yes, he doesn’t get it all right (two socks on one foot recently!), but we don’t seek to stop him trying and that’s all perfectly normal when parenting a 2-year-old. Of course we never parent an adult so this isn’t a perfect example, but it shows how in attitude terms as a society we generally support independence far better in younger people than older people.


Challenging assumptions

In my training and mentoring work this year I’ve talked to care home and home care staff about the need to challenge our assumptions about how much an older person can do. This starts from how we write care plans and talk in handovers and team meetings about the people we support. It also, most notably of course, then has to filter through into how we support people, understanding as much about their aspirations as their needs.

I mention the need for ‘fresh eyes’ a lot. When I do observations of course I am those fresh eyes, but for staff who support the same people every day it’s important to be able to take a critical view – look again, observe, rethink, then look again, observe and rethink. I signpost to various resources, tools and worksheets to support this in a documented way (the best way for trainers and managers to then follow up with frontline staff), so that we can really understand if a person supported can do some elements of their daily routine themselves but we are doing these things for them because we’ve assumed they can’t.

When re-thinking in this way, there are some important points to remember:

  • Abilities can fluctuate from day-to-day, hour-to-hour – what a person supported can’t do now, they may be able to do later or tomorrow. Don’t assume they won’t ever be able to do it ever again.
  • Adaptations can often mean the difference between someone being able to do something independently or not. Research what’s available to help the person be as autonomous as possible with personal care, tasks of daily living and their hobbies/interests.
  • Working side-by-side is the best way to be there if the person needs some support whilst enabling the person to do as much as they can for themselves. Resist the urge to take over!
  • For some people, expressions of independence are really small, so small we might not notice them. Be aware of this. Be observant!
  • Even in the last months/weeks of life a person can often do more than we think. Again, challenge assumptions and really understand the person.

It can feel quite overwhelming, maybe even frightening, for care providers to reimagine their care provision with more independence and risk for people supported, but with the right training for staff and good communication with people supported and their families lasting change can be achieved.

Thank you for all your support in 2022. Until 2023…

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