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Self Care Training Manual

Module 3: self care support - doing it for ourselves

Self care support is a new way of working, it focuses on involving people, motivating them and building their confidence so they can take better care of themselves; this is known as self care!

Module 3 gets learners to consider how their current care worker role sees them ‘dong for’ the people they support, by following set tasks on a traditional care plan. By repeating tasks over and over again care workers can get into the ‘habit’ of thinking they have to ‘do for’ people and without realising it take the control away from them.

New types of workers will develop new ways of thinking and approach their work by involving people, so they become active and can take control over their own support services.

Changing our habits is not always easy, and care workers will need to practise their new way of thinking if they are to support people to self care.

Learning outcomesOn completion of this module learners will be able to: � Understand how the current care worker role can limit individuals’

opportunities to ‘self care’ � Understand what ‘self care’ is and how we all make decisions about our

health and wellbeing � Demonstrate how a change in thinking can support individuals’ self care

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(OHP. 3.1 Module 3: Outcomes) � Understand how the current care worker role can limit people’s opportunities

to self care. � Understand what self care is and how we all make decisions about our health

and wellbeing. � Demonstrate how a change in thinking can support people’s self care.

(OHP 3.2 Your current role)The traditional operating system of homecare can put care workers in control of the people they support; by directing them to follow very set tasks on care plans, with little or no opportunity to allow people to make new choices or decisions about how they want to experience their care.

This way of working limits the opportunity for care workers and people to work alongside each other and plan new goals or new opportunities to improve the quality of their lives.

Under the traditional homecare system care workers must:

Follow the tasks on the care plan – these tasks are often set by the local authority or provider agency on behalf of the person – get up, wash, dress, make bed, prompt meds – and provide little detail on the choices people have made.

The tasks focus on maintaining people, so they don’t get any worse and can remain safe and secure in their own homes. Little focus is placed on improving them and empowering them to be involved.

Often ‘doing’ for the person they support – As the care plans are focused on lists of tasks that must be completed, care workers often end up just ‘doing for’ people. They get into the habit of arriving at a person’s home, not having to look at the care plan as they are so used to doing their tasks, and just getting on with them.

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Little time to ask the person, “What do you want to do?” – Providing care that focuses on tasks means care workers often feel there is little time to ask people what they want to do, how they would like receive their support and if there are any new choices they would like to make.

Little opportunity to try ‘new things’ with the person they support – By focusing on tasks, care workers get into the habit of doing the same tasks ‘day-in day-out’, at each visit they make with the people they support. This does not allow them the opportunity to set goals with the people they support so they can try new things.

Social and emotional needs not always seen as priority – We all have social and emotional needs no matter our age or disability. However, traditional care plans often focus on the person’s physical needs, with less focus on their emotional ones – how they are feeling and their social activities, how they contribute to the local community. This can lead to people becoming isolated and lonely, and affect their motivation to be involved and do more for themselves.

(OHP 3.3 This develops your habit centres)

I must just complete tasks when i visit

I can’t get involved in planning

I can’t do it if it isn’t in the care plan

If I don’t ‘do it’ then what will I do?

What are habit centres?Our habit centres are all the things we do without having to really think about them – brushing our teeth, getting dressed, driving our cars – we do these things over and over again until we don’t have to really think about ‘how we do them’.

Care workers have developed habits of ‘just doing for’ people.

This way of working has been determined by the training they receive and reinforced through policy and procedures in the workplace, supervision, on the job assessments and training updates. So for many years care workers have been trained, mentored and told to support people by following a list of tasks on their care plan.

Repeating a list of tasks on a care plan can mean getting into the habit of ‘just doing them’ without having to really think about what is being done.

Arrive at a person’s home; support them with the tasks that are in their care plan and then move on to support the next person with similar tasks on their care plan.

These habits repeat over and over, and before long care workers have programmed themselves so they don’t have to consciously think about the tasks they ‘do’. This is a natural response to repeating tasks.

We all fall into good and bad habits, it is the effects of them that new types of worker should understand, so they can begin to change their habit centres.

(OHP 3.4 Traditional habit centres – the effects) � Traditional habit centres can put you in control of ‘just doing for’ people. � This can focus you on tasks and limit the person’s self-determination to try

new things for themselves. � Little chance for people to self care.

No matter our age or disability we all have a human right to self-determination; it is what makes us unique and gives us control over our lives.

The effects of habit centres are that they can take self-determination away from people. This means people become less involved in doing things for themselves, and having less and less control about what is done ‘to them’.

‘I know my care worker has a good heart, but she comes in and gets on with it; I can’t remember sitting down and being asked what I want to do, or being involved in what she does. You learn to adapt though, it’s her job, you see.’

It is important that care workers can recognise that by simply ‘doing for’ people and not encouraging their involvement they can end up in a position of control. Now this is not a conscious decision; remember the way traditional homecare operates means care workers have to follow tasks on the care plan.

However, by focusing on the tasks that must be done, care workers can limit the opportunities people have to do things for themselves, and this takes the control away from them.

It limits their chances of getting involved, learning new skills and trying to do more for themselves.

! Key point: Traditional habit centres can stop people from taking responsibility for their self care and, as the ‘see-saw’ on slide 3.4 shows, can see care workers assuming control over the people they support.

(OHP 3.5 What is self care?) “…the individual taking responsibility for their own health and well-being ”

(Source: ‘Common core principles to support self care: a guide to implementation’, Skills for Care & Skills for Health, 2008)

Self care means each of us being responsible for: � Eating well � Being active � Managing our minds and our emotions � Managing our environments � Being involved in our communities � Understanding and caring for our long term conditions.

(OHP 3.6 Health and well-being is...)There are a number of ways to define health and well-being. The World Health Assembly (1948) defines health as:‘a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity’.

To simplify this, health can be thought of as all the choices we make to keep our bodies, minds and social lives in good shape. For example: � eating well � getting regular exercise � having enough rest and relaxation � drinking sensibly � not smoking � taking responsibility to look after ourselves � being able to socialise with others and in our communities � ensuring we are financially independent.

Making choices to maintain good health can be difficult when we don’t always have access to information and support that helps us to look after ourselves and stay healthy. We can end up forming bad habits, not eating the right foods, lacking exercise and not always caring for ourselves when we are ill.

When we have bad habits like this our health can get worse and our well-being can be affected too.

Well-beingWell-being is how we feel about ourselves.

If we are feeling low, lacking confidence and anxious, the chances are we are far less likely to look after our health conditions.

But if we are happy, confident and relaxed we are far more likely to be motivated to look after our health conditions.

So health and well-being go hand in hand.

! Key point:It is the new type of workers role to support individuals to balance their health and well-being so they feel positive, motivated and able to look after themselves.

(OHP 3.7 Group Discussion)What steps do you take to look after your health and well-being?

Please refer to discussion 3.1 in how to present module 3 in the Self Care Training Manual.

(OHP 3.8 Balancing health and well-being)Throughout our lives we take steps to balance our health and well-being, so that we can avoid illness and feel good about ourselves and our lifestyles.

For some of us:Being active, avoiding smoking and drinking excessive alcohol and eating well can reduce the risk of us getting certain diseases – (heart disease, cancer) and improve how we feel about ourselves.

For others:Eating a healthy diet, resting, and taking part in hobbies that interest them will reduce the risk of certain diseases (dementia and depression) and help them feel better about themselves.

Some people choose not to adopt healthy lifestyles and their unhealthy eating, lack of exercise, smoking and excessive alcohol mean they put themselves at risk of disease and poor mental health, or depression and anxiety.

Balancing health and well-being is not always easy, and will often mean changing our bad habits and learning new ways to care for our bodies and minds.

By taking the following steps, people can begin to improve their health and well-being:

Eating well - ‘You are what you eat’Too often, people do not eat a wide range of foods and their bodies don’t get the nutrients they need to remain healthy and fight off disease.

So, eating plenty of fresh fruit and vegetables, reducing the amount of salt in our bodies and avoiding saturated fats can help us maintain a healthy body weight and give us the nutrients we need to look good and feel great about ourselves.Our diet is therefore an important way to stay healthy and feel good about ourselves.

A healthy diet can: � Reduce the risk of heart disease and high blood pressure � Reduce the chances of getting cancer � Support weight loss � Improve bowel health � Improve the appearance and strength of skin, nails and hair

Living active lives - ‘We need active lives’We all live very busy lives, so taking the time to have plenty of exercise is important as it builds our stamina, our strength and helps to control our body weight. It helps support us to be healthy.

Being active can also have positive effects on our well-being, making us feel more positive and motivated to want to look after our own health and conditions.

It is important then that as we age we remain active, having some form of exercise in our daily routines. This may be walking, cycling, jogging, swimming or chair-based exercises, or simply getting involved in our own personal care and grooming; our daily activities.

Being active throughout our lives can: � Reduce the risk of heart disease, high blood pressure, diabetes, obesity � Help joints and ligaments to be more flexible � Increase energy levels � Relive stress and make us feel happier � Help us to maintain a healthy weight

Managing our feelings - ‘Don’t worry, be happy’Our bodies and minds are connected and play a big role in determining how healthy we are. So if we feel good about ourselves, the chances are we will be more motivated to take care of ourselves.

One way of supporting a healthy mind is to be involved with others, taking part in community activities, hobbies and making new friends. For some people, setting goals and having something to look forward to can help them feel better about themselves and give their minds the exercise it needs.

Healthy emotions can: � Reduce stress � Support our immune systems to fight off diseases � Make us feel positive about ourselves and the future � Increase energy and concentration � Build better relationships with those around us � Allow us space to start to look after our health conditions.

Taking control over our environmentsAs we get older, we will spend more time in our own environments, so ensuring they are well ventilated, clean, comfortable and not cluttered will reduce risks to our health and make them nicer places to live in!

Having enough money can also support people to make healthy choices about the foods they eat, the activities they are involved in and the amount of contact they have with friends, family and support networks.

Individual budgets will be handy, as people will be able to make their own choices about their environments and allocate part of their budget to keeping them comfortable in their own homes.

They will be able to access community activities and keep up with friends and family and purchase supports when they need it.

The benefits of maintaining a healthy environment are: � Reduce stress � Reduce the risks of becoming ill from surroundings � Feel happier about spending time at home � Maintain contact with friends, family and support networks.

! Key point: New types of workers have a responsibility to support people to balance their health and well-being. This means helping them make informed choices about their diet, exercise and the environments they live in, so they can feel good about themselves.

Having balanced health and well-being can mean people are more likely to self care.

(OHP 3.9 How we are taught to self care)Many of us would have been supported to self care from a very early age, learning skills that would allow us to look after ourselves and become independent of others.

Our independence is important as it puts us in control and allows us to make choices and decisions over how we live our own lives: what foods we eat, how much sleep we get, how much exercise we do, how often we go out, the hobbies and interests we become involved in, the friends we have.

These choices can determine how healthy and happy we are throughout our lives.

Our teaching

As babiesAs babies, our parents have an instinctive ‘want’ to see us do things for ourselves, to hold onto a bottle while being fed, to start to eat small foods and to take part in bathing and dressing.

We are encouraged, supervised and supported to continue to get better at self care skills.

As toddlersAs toddlers we have built the confidence to walk, even to run! Then brushing our own teeth and hair and dressing ourselves – with varying stages of success!

The motivation to want to be independent emerges and thanks to the continued support of our parents we want to continue to learn to do everything for ourselves – often through trial and error!

As young children As young children we begin to look at the detail – small buttons, shoelaces, letters and numbers – and begin to take control over our personal care needs; we have the knowledge to self care without always having to ask!

We develop further our communication skills and we may even start to rebel against other people ‘doing things for us.’

As young adultsAs young adults, the experience this rebellion brings helps us to plan how to become self-sufficient.

We are programmed to use our self care skills each day, brushing our teeth, hair, eating breakfast, lunch, dinner and taking a shower or bath without conscious planning or effort.

Our relationships begin to bring new social experiences and we become more involved with others who further our knowledge through their self care experiences. At this stage we start to think of extending our self care skills, and move away from our parents. We have acquired skills and knowledge and now we wish to ‘look after ourselves’ and not be ‘looked after’.

! Key point: Throughout our lives, we have relied on others to teach us how to self care, to give us the knowledge and skills to be independent and able to make choices that keep us healthy and happy. We should all hang onto our teaching and new types of workers have a responsibility to support people to continue to self care regardless of their age or disability.

(OHP 3.10 As older people)As we get older, our bodies change and the natural effects of ageing take hold. We may not be as steady on our feet or have as much strength as we used to, and for some people this means losing the confidence and ability they once had to self care independently.

To support their continued independence and to remain living in their own homes, many will use the support of community care workers. When this happens, and because they are using a support service, it is easy to think ‘they need us’ and that without support people would simply not survive, or be able to remain at home.

It is this thinking that can lead to bad habits and things being ‘done for’ people. This approach can put them at risk of losing their self care skills they have learned since birth!

Please refer to worksheet 3.2 in how to present module 3

(OHP. 3.11 Your new habit centres – self care support)Self care support is not about ‘doing for’ people, and it is not about simply following a list of tasks on a care plan.

It is a new way of working and can be thought of as: � New types of workers supporting people to be motivated and confident to

become involved in their lives � New types of workers supporting people to do more for themselves � New types of workers supporting people to take more responsibility for the

self care of their health and well-being.

For many care workers, self care support means changing their habit centres, so they can approach their work in partnership with the people they support.

This means every time they step through the front door, new types of workers are focused on involving people, so they can improve their self care skills and live healthier lives!

We know that people can make their own choices and decisions and will all approach managing their health and their well-being in their own personal way. Many will be used to having care ‘done for’ them, so self care support is about building their confidence and motivating them to change their behaviours towards their own care!

This means learning to set new goals with people and supporting them to achieve, and overcome challenges, so they can retain their rights to self-determination!

(OHP 3.12 Are people Interested in self care?) Self care principles“The Common Core Principles to Support Self Care aim to help health and social care services give people control over, and responsibility for, their own health and well-being, working in partnership with health and social care professionals. Consistent with the personalisation agenda they put people at the centre of the planning process, and recognise that they are best placed to understand their own needs and how to meet them.”

(Skills for Care & Skills for Health, Common core principles to support self care - a guide to support implementation, page 4)

Published in May 2008 the Common Core Principles to Support Self Care are a guide to help health and social care organisations think about how to support people to self care.

There are seven principles that outline how staff working in health and social care can change the way they work to give people the choice and control to improve their health and well-being.

� Principle 1 - Ensure people are able to make informed choices to manage their self care needs

� Principle 2 - Communicate effectively to enable people to assess their needs, and develop and gain confidence to self care

� Principle 3 - Support and enable people to access appropriate information to manage their self care needs

� Principle 4 - Support and enable people to develop skills in self care

� Principle 5 - Support and enable people to use technology to support self care

� Principle 6 - Advise people how to access support networks and participate in the planning, development and evaluation of services

� Principle 7 - Support and enable risk management and risk taking to maximise independence and choice

(Skills for Care & Skills for Health, Common core principles to support self care - a guide to support implementation, 2008)

(OHP 3.13 Are people interested in self care?) The Department of Health commissioned Market and Opinion Research International (MORI) to conduct a survey into public attitudes towards self care and self care behaviours.

The survey was conducted in two stages between August 2004 and January 2005, and the results include statistics from face-to-face interviews (a total of 3,290) with the general public in England.

� 95% of respondents said they were interested in leading a healthy lifestyle � 87% of those with a long term health condition said they were interested in

playing a greater role in self care for their condition � More than 50% who had seen a care professional in the previous six months

said they had not often been encouraged to self care � More than 75% said that if there had been guidance/support from a

professional or peer they would feel far more confident about taking care of their own health.

These statistics tells us that there is a place for self care support and a need for care workers to work in new ways.

People want to be able to lead healthier lifestyles and they want to learn more about their own long term health conditions, so they can stay in control of them and better look after themselves.

Supporting self care will allow this to happen, and mean that people can begin to become involved in their own care and support, learning new skills and taking over some of the ‘tasks’ that care workers would have traditionally just ‘done’ for them.For many, being able to self care in some areas such as personal care, mobility or medication means they will have more time and opportunity to set goals with their new types of workers in other areas of their lives!

(OHP 3.14 What is stopping us supporting self care?)People’s own attitudes and behaviours: � People have become used to having care ‘done to them’ � Rarely will they plan or set new goals to self care � They also focus on completing ‘tasks’ � Over time this can lead to them lacking the confidence to try new things and

to accept self care support.

People’s own attitudes and behaviours can stop them from self caring. As people get used to care workers coming into their homes and following tasks on the care plan, their ‘thoughts’ may quickly turn to acceptance:

‘She is here to do things for me’; ‘I don’t even say a word anymore and he can just get on and do it.’

The more people observe care workers just doing for them, the higher the chance that their behaviours will also change.

‘I am not getting involved, she is here to do it for me’; ‘ Can you just do this now, and then one other thing?’

The ongoing effect of having things done for them, and repeated on each visit, is to limit new experiences and means people’s attitudes and behaviours towards their own care and support is also focused on ‘tasks’ and having things done for them. Rarely will they plan to set new goals to ‘do things for themselves’ or consider new ways of looking after their long term health conditions and their well-being. So their ability to self care lessens over time as they get use to care workers coming in and ‘doing for’ them.

This inactivity can lead people to become dependent on their care workers and lack the confidence to try new things or to take responsibility for their own self care.

(OHP 3.15 What is stopping us supporting self care?)Care workers’ own attitudes and behaviours: � Care workers are used to following a list of tasks on the care plan � This can create an ‘I’ll just…’ effect � They don’t involve people in planning and setting new goals to achieve self

care � They worry that if people self care, there will be nothing for them to do.

Care workers’ own attitudes and behaviours can stop them from supporting self care, as they are mainly focused on completing their tasks when they arrive at a person’s home.

By focusing on ‘tasks’, care workers can end up ‘doing for’ people:

Over time the “I’ll just…” effect can limit the amount of self care people do and lead them to lose the skills they once had. If our parents had always ‘done things for us’ – dressed us, fed us, made our beds – the chances are we would have been dependent on them for far longer, and not developed the self care skills needed to be in control of our own lives.

By simply ‘doing for’ people, care workers can unknowingly take the responsibility to self care out of their hands and cause them to lose valuable life skills.

If people are to take responsibility for their own health and well-being then new types of workers need to see planning and setting goals as key to their new ways of working.

Supporting people to become involved and to self care should not be seen as ‘doing ourselves out of a job’. Once people are successful in their self care, new goals will be set and other areas become the focus of self care support.

! Key point: Self care support is not about making care workers’ roles redundant, it is about refocusing on people’s health and well-being and supporting them to be in control so they can live healthier and happier lives.

I’ll just make your bed I’ll just wash your face I’ll just pop it in the microwave

(OHP 3.16 Changing your thinking) � Changing your thinking is not easy. � Repeating a task over and over again means we can end up ‘doing it’ without

really having to think about it. � Care workers tend to think they have to ‘do things for’ people, and not always

involve them.

This pattern of thinking does not support individuals to be involved and to self care.

Changing your thinking is not easy! If you are right handed, now try and write with your left, and vice versa, and see how difficult the change ‘feels’.

Our brains have an amazing way of remembering patterns, so we don’t have to consciously think about how we do things all the time; these patterns build up and up and become ‘habits’ after a while, so we do them without thinking.

Care workers have got into the habit of ‘doing things for’ people. Now, we are not saying that should all stop immediately: for some people, owing to their physical or mental abilities, they will always need appropriate support, and this may mean ‘doing things for them’ to keep them safe and secure.

But for others, ‘doing things for them’ is purely down to work habits, when they could be doing for themselves (self care) no matter how big or small the contribution.

New types of workers will need to begin to change their habit centres, the patterns they have in their minds, if they are to support self care, and this means changing the way they think!

But... how do we change our way of thinking?

Please refer to worksheet 3.3 in how to present module 3 in the Self Care Training Manual.

(OHP 3.17 Remember your new habits) Any change in thinking can be difficult, and will not happen overnight, so it is important that new types of workers regularly challenge their thinking and:

� Identify what they don’t want to do anymore “I don’t want to just ‘do for’ the people I support anymore”

� Identify new ways of doing things “I want to involve people so they can eventually do things on their own to self care”

� Practice their new habits “I have always worked in the old way, so it is OK if it takes some time to change – but I will keep practising”

New habits will eventually become automatic!

(OHP 3.18 Your new habit centres will...) � Allow you to work with people and involve them in their activities � Balance the control and support people to make new choices about how they

receive their support. � Promote self care! � Make your role more interesting!

As New Types of Workers practise their new thinking and challenge their old ways of working, they will begin to notice a difference to how they approach supporting people, and move away from thinking:‘I am here to just do what is on the care plan’

This new way of thinking will mean new types of workers are more likely to involve people in their personal care, their mobility and their daily living activities, and work with them to gain more control over their own health and well-being.

This new way of thinking will mean new types of workers are more likely to involve people in their personal care, their mobility and their daily living activities, and work with them to gain more control over their own health and well-being.

By thinking in a new way and working in a new way, new types of workers can support people to be in control, and increase their confidence to make new choices and try new things.

New habit centres will mean new types of worker being advocates of self care, arriving at a person’s home and having the automatic thought of:‘I am responsible for supporting self care and improving the skills of the people I support.’

As people make new choices, so the role of the new type of worker will become more varied, and move them away from just maintaining tasks on a care plan, to planning, setting goals and improving the person’s skills to live healthier and happier lives.

! Key point:Remember self-determination means we all have a right to make choices and decisions about how we live our lives, no matter our age or disability, and, where we are unable to, our choices and decisions are made in our best interests.

(OHP 3.19 How are we going to make self care support happen?)Self care support will only happen if care workers can change their habit centres from an “I’ll just…” approach to supporting people to become active, involved and motivated to self care for their own health and well-being.

Making self care support happen will rely on: � building person-centred partnerships � understanding the ‘labels’ and ‘symptoms’ of long term conditions � using the ICE (ideas, concerns, expectations) TOOL to gather information � setting goals and overcome challenges � signposting people to other services � upholding choices by reducing risk � learning about assistive technologies to support self care.

! Key point: The key points above outline the role and responsibilities for new types of workers and will be explored in greater detail throughout the training.

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