CHCICS301A Provide support to
meet personal care needs
Reading 4: Recognise and report
changes in client health and/or
personal support requirements
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© NSW DET 2009
Contents
Reading 4: Recognise and report changes in client health
and/or personal support requirements
3
Introduction
3
Identify variations in personal care support requirements and
report to supervisor
3
Work with person and supervisor to identify required changes
to processes and aids
4
Identify variations and concerns about client’s health
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Report variations and concerns about client’s health to the
supervisor
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Reading 4: Recognise and report
changes in client health and/or
personal support requirements
Introduction
It is good professional practice to establish an organised way of observing.
Assisting clients with personal hygiene is a good opportunity to observe
skin integrity, communication skills, orientation to time and date for
example, and any changes in behaviour. Transferring clients from one
position to another can provide an opportunity to observe mobility. If you
are not watchful during all interactions with clients then changes will be
missed.
Identify variations in personal care
support requirements and report to
supervisor
Reporting changes in a person’s condition
Observing clients is a vital part of the aged care and health support worker’s
role. To be able to report changes in a client’s condition or needs, the carer
must be a good observer. To observe people in your care, you must use ALL
your senses. Observing is much more than just looking at the person.
Anything unusual or out of the ordinary should be noted and reported to the
supervisor. For example, you may smell a strange odour, hear a moan or
groan or feel an unusual swelling or lump on the skin.
It is important to know your client to be effective in the care you give.
‘Care’ includes being attentive to change and reporting any changes to the
relevant person. The worker must first know what is ‘normal’ before they
can recognise what is not normal. The age, gender and known medical
condition and diagnosis of the client must be kept in mind
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Accurate, objective reporting is a skill, which needs practice. The reports
made by a worker often affect the type and level of support the person in
care will receive. Reports which are inaccurate, and coloured with personal
interpretation and perceptions, may result in inappropriate support and
assistance to the client.
Aged care and health support workers should consult the client about their
observations wherever possible, to make sure that what they have seen is
accurate and true.
Aged care and health support workers should also ask the following
questions:

What information is relevant to report?

What information is not relevant to report?

To whom should I report the information?

When is it appropriate to report?

Have I reported objectively and without value judgement?

Have I consulted the client and obtained their consent to pass on the
information I think needs to be given?

Do I have enough information about the issue?

Is it necessary for me to consult or seek advice form anybody and
am I clear who that person should be?
Work with person and supervisor to
identify required changes to processes
and aids
Contributing to the delivery of a service/care plan
There will often be occasions when workers need to seek advice and
direction about implementing a service/care plan, for example, aged care
and health support workers may be unsure about a decision they are making
or concerned about some aspect of the daily care tasks.
To know when it is appropriate to seek advice workers should be aware of
their role and responsibility in the care of a client. This will be identified in
general terms in their job description and more specifically in a service/care
plan.
Aged care and health support workers should also be familiar with the roles
of the care team members who may be included at any one time with a
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client. This could include health workers, doctors and immediate
supervisors.
Workplace policies and procedures may also provide guidelines about when
and how to seek advice and direction. For example:

a staff information booklet may identify the staff to whom you
should report or seek advice

in addition to policy guidelines and formal processes, information
may be given verbally to indicate what to do in the care of
emergencies.
Consulting the client
Often the person to consult in the first instance is the client. For example:
Mrs Avarti has been prescribed tablets for a heart condition. You notice
that she has not taken the last two doses and need to find out why.
Although you will need to report this situation so that it can be further
investigated, it is important that you first seek accurate information from
Mrs. Avarti. Consulting her will also show your respect for her dignity.
If unsure of the client’s competence, the aged care and health support
workers may need to have a discussion with their supervisor or seek advice
from a professional worker before consulting the client.
Consulting a supervisor
There may be many occasions when aged care and health support workers
should seek advice from their supervisor about a decision which must be
made immediately about a client in their care. This may require a telephone
call if the supervisor is not on site.
Note: If a supervisor is not accessible and you are faced with an emergency,
use a common sense approach. Place the person out of danger and acquire
assistance. If you are in an isolated situation you could contact emergency
service personnel, eg the police, ambulance or fire services.
Often a decision may be difficult to make. For example, when a decision
involves the client’s right to choose to take a risk, the aged care and health
support workers may wish to seek support as well as advice form their
supervisor.
Seeking advice and direction from a supervisor is crucial to the role of
monitoring the effectiveness of the service/care plan. For example, the
service/care plan for Mr. Millthorpe states that he had a hip replacement and
should use a walking frame for four weeks, but he tells you that he does not
use it or need it any longer. It would be appropriate for you to respond to
Mr. Millthorpe in helpful way, informing him that you need to obtain advice
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and direction from your supervisor and that a reassessment may be required.
In this way you will be directly working within the service/care plan and
contributing to the evaluation and development of ongoing and changing
needs of Mr. Millthorpe.
Consulting within a team
When it is decided that immediate action is required it is necessary to
consult with your supervisor. In cases of less urgency, there are formal ways
such as regular team meetings where advice and direction can be obtained.
Meetings provide the opportunity for members of the team to review the
effectiveness of care and to gather information to help implement the
client’s service/care plan. Sharing ideas and strategies also provides aged
care and health support workers with support.
Consulting documentation
Workplace policies and procedures provide a form of indirect supervision
for workers in their daily implementation of care. They provide guidelines
for work as well as help to keep the quality of care consistent. The nature of
the forms and requirements will vary from workplace to workplace.
However there are several which are commonly found. These are:

Incident report forms – where there has been a particular incident,
which directly affects you and/or the client.

Communication books – which detail each service performed and
records the daily status of the client.

Progress notes – to record daily status or events.

Problem sheet – where specific problems arising for the client are
documented and used on a daily basis.

Treatment sheets – to indicate specific treatments, which have been
carried out for the care of the client.

Handover books – in which you report at the end of each work shift
to ensure consistent care for the client.

Case histories – detailed history of a person’s health status, life
history, services given and any other relevant information.

Assessment sheets – used to assess the strengths, abilities and
identified needs of the person before the planning for care. These
documents car vary depending on the service the person is being
assessed for.

Continence management charts – used to record ways of assisting a
person to mange incontinence problems and ensure that there is a
consistent monitoring and use of these strategies by the team.
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
Activity sheets – listing programs and activities that a client may be
involved in at a day activity centre or in an aged care facility.
Identify variations and concerns about
client’s health
Areas of personal preference
On a day-to-day basis in your work you will come across a variety of
different personal preferences. Each individual will have different needs in
all aspects of their lives. You may find preferences in their daily living in
areas of:

communication

eating and drinking

mobility and transferring

attending to personal hygiene

dressing and undressing

spiritual needs

grooming

emotional needs

expressing sexuality.
In dealing with any variations and concerns about a client’s health the
responsibilities of an aged care or health support worker include:

Clarify what the service/care plan asks aged care and health support
workers to do. Speak with your supervisor to get clear advice and
direction.

Monitor effectiveness of the service/care plan. Be aware of the
individual client’s personality and what they need and expect from
aged care and health support workers. Constantly make sure the
service/care plan is meeting the needs of the client.

Report any changes or concerns about the client’s welfare or
wellbeing using the appropriate workplace procedures.

Carry out care while maintaining the respect and dignity of the
client.
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How to recognise personal preferences
Many of your clients will be quite comfortable discussing directly with you
their personal preferences. Others may find this difficult because:

They desire to remain independent. It can be very difficult for an
older person to ask for help to fulfil simple tasks that they have been
capable of doing all their lives. This dependence on someone else
can be embarrassing.

Cultural differences may make it difficult for an individual to
communicate their personal preferences – language difficulties,
difficulties in accepting help from a young person or someone of the
opposite sex.

They do not want to be a bother.

Difficulties in communication, especially sensory impairment.
Situations may change for the client. These changes may make it more
difficult for aged care and health support workers to carry out tasks outlined
in the service/care plan. Such changes can occur as a result of improvements
or deterioration in a client’s strengths, abilities or conditions.
Here is an example:
Mrs Martin has always required help in dressing. Lately she has preferred
to dress herself, even though she is having difficulties which are obvious
to the carers. When approached by a carer as to why she was now dressing
herself, she admitted that she would like to continue dressing herself
because she recently saw herself in a mirror and was embarrassed by the
loose skin hanging from her arms.
This example illustrates a number of issues. The level of classification needs
to be reviewed in light of Mrs. Martin’s preference because this is going to
affect the funding subsidy for her care and the instructions in her
service/care plan. There is a conflict of interest between the:

duty-of-care to encourage and enable her to be as independent as
possible

duty-of-care in respecting her own perception and her needs

criteria for eligibility for funding subsidy in personal care.
Responding to difficulties effectively will require clear communication
skills as well as an awareness of your role and responsibility. Aged care and
health support workers will need to:

be clear about the tasks required by the service/care plan

know how to respond to the immediate situation

report clearly any issue that is not meeting the service/care plan
requirements.
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
Any conflict felt about obligations and responsibilities should be
discussed with your supervisor.
Reporting objectively
To observe objectively, aged care and health support workers should:

report or record only what they see and hear, not what they think and
feel about a situation.

report without making a value judgement from their perspective.

always check the behaviour to validate that the behaviour is different
to their normal behaviour

always communicate your observation to the individual concerned to
get more information about their behaviour and to show compassion
and respect.
Report variations and concerns about
client’s health to the supervisor
There is a plethora of expected physical health changes due to the ageing
process.
All older people will experience these physical changes, some to a lesser
and others to a greater, degree. The major ones include:

Sensory: decline in eyesight, hearing, smell, taste (especially for
smokers) and sometimes touch.

Skin becomes thinner, fatty tissue thins and skin wrinkles and sags,
sweat glands reduce.

Fat distribution: muscle is replaced with fatty tissue, middle aged
spread appears and is difficult to shift.

Brain and nervous system: long term memory remains in tact,
intelligence is generally unchanged, but there may be slight
impairment to short-term memory, new learning and the ability to
focus and concentrate, reaction time slows, body temperature is less
regulated.

Heart and blood vessels: blood flow reduces from thickening
arteries, heart responds slower to increased demands for blood when
reacting to stress or exercise.

Bones/skeleton: discs in spine become thinner, bone density
decreases, may shrink in height.

Posture: some develop a stoop over time as muscle contract more
slowly.
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
Mobility: less endurance for sustained exercise and activity,
combined with a loss of strength.

Joints: cartilage is worn away, tendons are less elastic, restricted
movement in joints, muscles, ligaments and tendons deteriorate.

Dental health: teeth need constant maintenance or will decay,
destabilize, discolour, gums recede.

Lungs: less air moves through the lungs, therefore less oxygen gets
into bloodstream.

Immune system: more susceptible to infection because defence
mechanisms are reduced.

Kidneys become less efficient (may need to urinate during night).

Genitals: testicles may drop, prostate enlarges, may cause difficulty
urinating, sperm reproduction may also reduce.

Hormonal changes, menopause in women.

Hair becomes grey and thins.

Sexual function: may take longer to stimulate and slower to reach
orgasm, but is still encouraged.
Common risks to a client’s safety
A risk is a situation, which has the potential to create a hazard to a person’s
health, safety or wellbeing. Risks which occur, because of the process of
ageing can be physiological, psychological, emotional or environmental.
Risks are found in all environments. However the amount of actual risk to a
person will vary, depending on the particular environment and on the
number of personnel and checks in place to monitor and minimise risk.
Risks which may result, from the ageing process include:

falling

injury

poor nutrition

infection

getting lost or disoriented

rejection and loneliness

financial abuse

neglect by aged care and health support workers

elder abuse.
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Factors that lead to increased risks for older people
Some older people need to depend on others in order to fulfil daily tasks.
The level of their dependence is directly related to how their body ages.
When you consider the potential risks to an individual’s health and safety it
is important that you understand the ageing process and the effects it has on
the body.
As people age they may have physical limitations in performing daily
activities and are less able to cope with hazards in their living environment.
As we have seen, the ageing process can increase risk of injury due to
changes in body systems.
Balancing personal preferences, rights and safety of your
clients
Clients have the right to make decisions that may include the acceptance of
personal risk. Aged care and health support workers have a responsibility to
ensure that safety hazards and situations of risk are minimised for clients,
however, it is not possible to protect them from all potential hazards. It is
important that you understand the difference between the client’s rights to
live with risk and staff neglect. It is important that you carefully consider all
of the implications when considering preventing clients from fulfilling
personal preferences or independence because of possible risk situations.
The freedom that an individual is given should be balanced with stability
and security.
Whilst allowing clients to maintain their independence and fulfil personal
preferences it is essential that their own safety and the safety of others are
taken into consideration. The perfect example to illustrate this is that of
smoking. A client who lives in a residential care facility will have the right
to smoke. However they will only have the right to smoke in designated
areas. This means they may not be allowed to smoke in public areas, their
bedroom of in their bed. This rule will have been introduced in order to
protect the safety of all residents and all staff rather that just to limit the
freedom of the individual.
It is not easy to respect the person’s needs and personal preferences while
trying to ensure that they are safe. You will be faced with many situations
where you have to weigh up the person’s rights and individual preferences
against safety factors. There may also be times when the individual places
not only themselves at risk but others at risk as well.
It may be that a client is happy to receive assistance. It may also be possible
through discussion to provide clients with alternative approaches to
fulfilling their level of independence and personal preferences. It may be
that only a small change in routine or the way in which a person performs a
task is all that is required to eliminate the risk.
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Observation, of any of the above, report immediately, to the Registered
Nurse or supervisor and document the situation in the notes.
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