Having difficult conversations with consumers
4 minute read
Implementing the new trauma-aware and healing-informed approach is likely to be a challenge for many providers as they attempt to train their staff and support workers about what this means in the context of the care and services they deliver. It is important to note that these new-to-home-care concepts are being added to a long list of existing ‘difficult’ topics that are currently not particularly well embedded into practice, and there are a bunch of reasons for this.
Assessment fatigue
By the time a home care provider meets their new consumer for the first time, we know that the consumer has already been subjected to numerous assessments, endless questions and long wait times. They may be feeling overwhelmed by the prospect of yet another lengthy onboarding process with you.
The Aged Care Quality and Safety Commission expect home care providers to know a lot about their consumers and they expect you to have conversations about some difficult or sensitive topics. But we all know that there is never really a ‘good’ time to raise some of these topics like advance care directives, elder abuse, loneliness, end-of-life care, and so on. So asking about these issues during an already deficit-heavy assessment conversation is often a step too far for both parties.
Assessment demands
There is an expectation detailed throughout the Aged Care Quality Standards that home care and CHSP providers will have these discussions with their consumers early on, as it is believed it will make a difference in the way care and services are delivered and received.
But in my extensive experience working with providers to review and improve their assessment processes, I can tell you that almost every care manager I have ever spoken to, does not like asking these sorts of questions, and much of the time, they either skip the question altogether, or they ‘tick and flick’ and quickly move on to something less awkward for them both.
This is not a criticism of care managers at all – it can be a tough and often thankless job at times, so building trust and rapport are paramount to the ongoing success of the relationship. Many care managers avoid these issues as they either feel uncomfortable themselves, or they don’t want to be perceived as being offensive, confronting or intrusive as they are getting to know each other.
Understandably, the new care manager will want to get through their assessment documentation as quickly as possible and focus on the main issues to build an interim care plan and budget and get some care and services in place for the consumer right away. This very well-intentioned approach sometimes means that certain sensitive questions are skimmed over, and these are the types of questions that require sensitivity, rapport and time to explore with the person.
Consumer reluctance
Sometimes consumers might also avoid discussing these difficult topics if they feel uncomfortable or if they’re not sure how to respond. Sometimes there are cultural reasons why these topics are not meant to be talked about with people outside the family. But did you know that many older people do want to talk about these things with someone they trust but don’t know how to raise the topic either? The thing is, we don’t know where people stand on this if we don’t ask.
So how do care managers respectfully introduce these topics to a person they have often only just met?
Discussion topics checklist
We have consistently found the use of a simple self-assessment tool is a great way to ease everyone into the conversation at a pace that is controlled by the consumer and provides a roadmap for how each of these conversations can roll out over time.
These tools promote autonomy, control, reflection and respectful dialogue between all parties by giving the consumer time to think things through for themselves and to decide what level of engagement they intend to have with their care manager on each of the topics presented. When the self-assessment tool asks if they want to discuss each of the topics, the person may choose to answer Yes or No, depending on how they feel at that time. They may choose to defer the conversation to another time, and some might want the care manager to provide them with some information about the topic so they can read about it in their own time.
These days it is more important than ever to demonstrate the value of quality care management. Current Standard 2 (& Strengthened Standard 3) details the responsibilities of providers around assessment and planning, with strong references to partnerships and engagement with all consumers.
What better way to show your commitment to these outcomes than by introducing a consumer-guided plan to tackle some of these complex concepts, which empowers consumers by guiding the process in their own way. It helps them to feel in control and to be heard. This is what true partnership is all about!
Similarly, you can demonstrate that the consumer is being prioritised in the engagement process, showing how you have respectfully introduced the topics and allowed the consumer to think about how they’d like to respond. It’s a great idea to use this tool with family carers too, so you can create some space for them to have purposeful conversations with you about their needs.
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