A Change of Approach

23 October 2017
Blog post

In late 2015, I moved services to oversee a supported living home. The staff came across as caring, supportive and wanting to help people with their daily activities and life skills. The staff team is mostly female staff- which is not a problem at all, however I did notice that their approach to the people we support was more motherly than adult to adult support.

It took some time to explain to the staff what I was expecting to change and to see that change happen. It took a good year to chip away at this approach of over supporting as I really did not want to break the relationships that had grown over the years between the people we support and staff, but I wanted to make it an equal relationship: adult to adult.

How change happened-

When I came across to work at St James, I was asked by the compliance team if Bernard required support with personal tasks. If he could not do certain personal tasks for himself it would mean that he would be regulated under CQC.

I could see that Bernard was being supported with things like zipping his coat up, lacing his shoes, brushing his teeth and shaving and I thought to myself “Why this is happening? Could Bernard do the tasks himself? How could I make the tasks achievable for Bernard?”

I carried on observing the staff supporting Bernard, asking questions when certain personal tasks were taking place. “Why did you lace his shoes up?” I would be informed “He can’t do it”. I would ask “Why don’t we buy shoes that have Velcro across them?” Staff would reply “I suppose we can”.

I could see the warmth staff had towards Bernard, how much they made sure that he was healthy and looking well, but I began to challenge the way things were being done. I made sure I did not overwhelm the staff who were carrying out tasks, by carefully using the facilitation skills to support them to stop and reflect on what they were doing and how things could be different.

Due to staff shortage I had to cover shifts and I started to encourage Bernard to do certain tasks for himself. I was amazed! I would stand back and say “Lace your shoes Bernard” and you can imagine my surprise when he did this with ease. I would say “Zip your coat up please” and Bernard did it, no problem at all.

I began to encourage more stepping back from the staff team, explaining that I understood the care and the support they were giving, but we needed to start to empower Bernard to do more for himself.

I spoke about the 10 facilitation skills with each member of staff; breaking it down and relating the skills to the support that member of staff was giving. Now, after a good year and a half, I can see a big difference. Things have changed… a lot!

Staff are asking themselves questions before supporting people and also reflecting afterwards. They are thinking “Why am I doing this for this person?” “What can I do or change so this person is able to do the task themselves?”

Staff are being more creative- one example pops to mind. Bernard’s money is kept in his safe which is located in his room. Bernard can at times say “no” to staff entering his room, so it was difficult to access the safe for his money. To cut down on his anxiety when staff go into his room, staff now give Bernard the safe keys and he will get his money box out of the safe and bring it to the staff and also return it.

I am pleased to say that Bernard now laces his shoes- staff have stopped doing this. He is encouraged to brush his teeth and has an electric shave with just some verbal prompts. Staff are being responsive, stepping back a lot more and only stepping in when needed.

Taking the approach of ‘we are all adults, let’s treat each other equally’ has had a big impact in the house: paperwork we would normally fill out, like best interest, we are encouraging the person to do it themselves; arranging holidays, where possible the person is booking it over the phone themselves.

The support we provide has changed from ‘motherly’ to using the 10 facilitation skills: we now encourage people to take control.

Sandra Hughes

Frontline Leader