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The contents of this document are OFFICIAL.
Understand supports for participants who need help to move around in shared living arrangements
Guidance in this document is not approved for use unless you view it in PACE.
This article provides guidance for a home and living delegate, planner delegate, review officer and planner (non-partnered area) to understand:
• participants who need support to move around • shared supports • individual supports in a shared arrangement • level of support • support to transfer and move around • personal care tasks.
Recent updates
4 November 2024
New article to help you understand when participants who need help to move around can use shared support in a shared living arrangement. It will also guide you in determining the level of support needed for these tasks.
Before you start
You have read and understood:
• article Understand supports for participants who can move independently in shared
living arrangements • Our Guideline – Reasonable and Necessary Supports (external) • Our Guideline – Supported Independent Living (external) • Our Guideline – Creating your plan (external) • Our Guideline – Your plan (external)
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• Requesting home and living supports (external) • Personal care supports (external) • article Understand disability-related health supports – core supports • article Apply the home and living decision in PACE • article Add supported independent living (SIL) funding.
To learn more about supports for participants who can move around independently, go to article Understand supports for participants who can move independently in shared living arrangements. The guidance below complements this article and describes the differences and additional considerations for participants who need support to move around.
Go to section Assessments or reports to support decision-making in article Understand supports for participants who can move independently in shared living arrangements to learn more about information and evidence allied health professionals (AHPs) can provide.
Participants who need support to move around
This includes participants who:
• use assistive technology (AT) to move around. For example, using a ceiling hoist to
transfer in and out of furniture, a walking stick, wheelchair or four-wheel walker to
move around their home. • live in a home that has accessibility features. For example, home modifications (HM)
or Specialist Disability Accommodation (SDA). • need person-to-person support to move around to complete personal care tasks. For
example, a participant with reduced mobility in their arms and hands may need help
from another person to complete tasks like brushing their teeth. • need assistance from another person to use their AT. This could be help from a
support worker to move in and out of a hoist.
Shared supports
In a shared living arrangement, there are tasks shared by all participants in the home. A support worker can help more than one participant at a time to prompt, guide or set up tasks. To learn more, go to article Understand supports for participants who can move independently in shared living arrangements.
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There might be another support worker in the house to help during periods of high activity, like in the mornings and evenings. This could look like 2 support workers helping 3 participants in a responsive and flexible way.
There are also times the participant may need active individual support for a short period of time. For example, to help safely transfer the participant out of bed, with or without AT.
Individual supports in a shared arrangement
The level of support provided will depend on the participant’s functional capacity. When we say functional capacity, we mean things the participant can or can’t do themselves. This support could be helping the participant to do a task or doing the task for them.
In addition to reading about individual supports in article Understand supports for participants who can move independently in shared living arrangements, also think about:
• the participant’s physical capacity to complete a task. Can the participant complete the
task if they use AT? Do they still need support worker assistance to complete a task? • the impact of the participant’s disability on their ability to move. Does the participant’s
disability impact their arms, their legs, or both? How much is the participant able to
move without help?
If you don’t have enough evidence or information, discuss next steps with your team leader.
2-person individual support
Sometimes the participant might need individual support from 2 support workers to help them complete a task. This is 2-person support. For example, 2 support workers may be needed to help the participant to shower safely. One support worker can provide active support for the participant while the second worker moves the AT into place, or out of the way. The second worker might help with part or all of the task.
If the participant needs individual support from more than 2 support workers, you need evidence that describes this. For example, a manual handling plan from an occupational therapist and incident reports which highlight risks for the participant if the second support worker isn’t available. After speaking with your team leader, if you’re still unsure about the right level of support, you can request advice from the Technical Advice and Practice Improvement Branch (TAPIB). To learn how, go to article Create a technical advice case.
Level of support
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Use the information below to help you understand the level of support the participant may need. Think about whether capacity building supports would help to develop the participant’s skills and decrease the level of support needed. Look at the participant’s circumstances, including their level of engagement and ability to complete the task.
No additional support needed
The participant can independently complete the task with or without AT and no additional hours of individual support is needed. In a shared living arrangement, there is support available over a 24-hour period.
Minimal level of support needed
This can include verbal prompts or gestures like reminding the participant to brush their hair or teeth during their daily grooming routine. This can also include help with things like picking up an item off the floor when the participant is unable to pick it up themselves.
Partial level of support needed
This means active support provided by a support worker to complete part of the task. This may be a support worker moving a participant from their bed to a wheelchair using AT, or positioning AT for the participant to complete a transfer or movement.
This can also include help with part of a task like helping set up AT and transferring into the shower when the participant cannot stand without support. Once in the shower the participant doesn’t need help completing the task.
Full level of support needed
This means the participant needs a support worker to do all parts of the task. Think about the participant’s capacity to complete or engage in any part of the task and how this may change the time needed to complete the task. If the participant can’t help or has limited capacity, individual support may be needed.
This can include things like the support worker helping the participant raise their arms while showering. It can also be when a second support worker helps for a short period of time with washing, or to complete a transfer. After this period, the second support worker returns to support other participants in the home.
Complex level of support needed
To learn more about this level, go to Complex level of support in article Understand supports for participants who can move independently in shared living arrangements. In addition to this information, a complex level of support may be when a participant needs more than one support worker to help with a task.
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Support to transfer and move around
Think about the participant’s needs and functional capacity to help you decide the right level of support for a participant in a shared living arrangement who needs support to:
e transfer with or without AT, for example from lying in bed to sitting, or from sitting to standing
e move around their home or the community with or without AT.
Shared or Individual Example
No additional |Shared The participant can independently move support around using AT, like a walker or wheelchair needed but doesn’t need help to move AT into place.
For example, the participant uses a slide board to transfer into their wheelchair and move around.
They may have an electric bed to help them independently reposition in bed, instead of help from a support worker.
Minimal Shared The participant may need a reminder, support supervision or help to set up or position their needed AT so they can move around or transfer safely.
Or they may need a prompt to move or turn in bed or reposition.
Partial level of |Shared or individual The participant may need active support to turn
support support for up to 60 in bed or reposition in their chair from time to
needed minutes per day, time. They might need help using their AT, depending on the such as an attendant-propelled wheelchair.
participant’s needs and
” ; The participant may need help to transfer, functional capacity.
either with or without equipment. For example, they could use AT to move to and from their wheelchair or as support while doing a pivot transfer. Once transferred, they can move around the home either with or without AT.
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Full level of Support to move around: The participant needs help from a support support worker for all mobility. For example, using an Shared or individual needed attendant-propelled wheelchair and moving to support for up to 90 a different room, or from one activity to minutes per day, another. depending on the participant’s needs and The participant needs active support to functional capacity. complete all parts of the task. For example, a support worker to place a slide board into Support to transfer: position and then provide active support to Shared or individual transfer. A second support worker may help support for up to 120 with part of the task. For example, hoist in and minutes per day, out of a wheelchair. depending on the participant’s needs and functional capacity.
Complex level Individual support based The participant needs AT and active, individual of support on AHP reports and support from another person to move around. needed assessments. For Or the participant needs active support from 2 example, a manual support workers to complete transfers. handling plan. They may also have behaviours of concern which present a risk to moving safely or being transferred. This might look like constant redirection and implementing positive behaviour support strategies to use AT or move around.
Personal care tasks
Make sure you read and understand the Personal care tasks section in article Understand supports for participants who can move independently in shared living arrangements.
Note:
• Funding for personal care tasks in shared living arrangements is included in the Home
and Living support category. • For all tasks, no additional support is needed when the participant can independently
complete the task with or without AT.
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For Internal Use Only The information below identifies the differences and additional considerations for participants who need support to move around. Showering, bathing, dressing and personal hygiene
When the participant needs a minimal level of support for these tasks, use information under Showering, bathing, dressing and personal hygiene in article Understand supports for participants who can move independently in shared living arrangements.
Level of Shared or individual Example
support
Partial level of | Shared The participant may need assistance to move AT support into place before completing self-care tasks. needed
Full level of Shared or individual _|The participant may need active support to get
support support for 120-180 into the shower or bath, using AT like a shower needed minutes per day. chair or a hoist. They need active support to Note: the 180 minutes apply soap and hygiene products and to dry
per day could be for themselves.
one support worker or shared by 2 support workers for up to 90 minutes each.
Complex level | Individual support The participant needs active, individual support of support based on AHP reports |longer than 120-180 minutes per day. needed and assessments
Skin integrity care
Level of Shared or individual Example
support
Minimal level |Shared The participant doesn’t have an active pressure of support injury but may need a prompt to apply protective needed cream. Or to reposition to avoid an injury.
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Level of Shared or individual Example
support
Partial level of | Shared The participant may need help to pick up or get
support products, open tubes or jars and unscrew lids or
needed caps. They may need help to set up and apply the product or reposition the affected limb or areas.
Full level of Shared or individual |The participant doesn’t have an active pressure
support support for up to 90 injury but needs a support worker to help them needed minutes per day, reposition every 2-3 hours to avoid injury. depending on the
Or they need active, individual support from a support worker to prevent pressure injuries by applying barrier creams.
participant’s needs and functional
capacity Complex level | Individual support The participant has an active pressure injury and of support based on AHP reports |needs one or more people to dress wounds or needed and assessments reposition.
including a wound management plan or pressure care plan
Or they need help with complex pressure care support maintenance. The participant may also have behaviours of concern, including self-harm or removing bandages or dressings.
Note: For more information, go to article Understand disability-related health supports — core supports and Our Guideline — Wound and Pressure Care Supports (external).
Toileting
As well as information under Toileting in article Understand supports for participants who can move independently in shared living arrangements, also think about:
e if the participant is able to position themselves in the bathroom, onto the toilet and remove clothing. For example, move from a 4-wheeled walker to the toilet, sit down and then return to their 4-wheeled walker.
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Level of Shared or individual Example
support
Minimal level | Shared The participant may need occasional support to of support position AT or undo clothing.
needed
They may need some supervision while using the bathroom or completing these tasks.
Partial level of | Shared The participant may need some support to lift the support lid of the toilet and push the button to flush. needed
Full level of Shared or individual |The participant may need active support to take
support support for 60-120 off or put on clothing for toileting, to sit down or needed minutes per day, stand up when using the toilet, or to help with depending on the wiping or washing hands after using the toilet. Or participant’s needs they may need short instructions or prompts to and functional complete each task correctly. capacity Complex level |Individual support The participant may need AT and active support of support based on AHP reports |from one or 2 support workers to complete all needed and assessments aspects of toileting.
Changing or using continence products
As well as information under Changing or using continence products in article Understand supports for participants who can move independently in shared living arrangements, also think about:
e if AT is needed to change continence products.
When the participant needs minimal or a partial level of support for these tasks, use information under Changing or using continence products in article Understand supports
for participants who can move independently in shared living arrangements.
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Level of
support
Full level of support needed
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Shared or individual
Shared or individual support for 30-60 minutes per day, depending on the participant’s needs and functional capacity
Example
A second support worker may be needed to help with parts of these tasks.
Complex level of support needed
Individual support based on AHP reports and assessments
The participant may need help from 2 support workers and a hoist or AT to change their continence products. This may include help to maintain hygiene, wash and get dressed again after incontinence.
Eat, drink and manage a mealtime plan
As well as information under Eat, drink and manage a mealtime plan in article Understand supports for participants who can move independently in shared living arrangements, also
think about:
e if the participant can use their arms and hands functionally. Participants without
functional use of their arms will need more support.
Level of Shared or individual Example
support
Minimal level |Shared The participant may need a support worker to get of support items from a high shelf or to place cutlery, a plate needed or cup within reach.
Partial level of | Shared The participant may need help to set up or support position their AT like modified cutlery or plates. needed They may need some help to cut food into small
pieces but can eat and drink independently afterwards.
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Level of Shared or individual Example support Full level of Shared or individual __| The participant may need active, individual support support for up to 90 support to follow their mealtime management needed minutes per day, plan and eat their meals safely. They may need depending on the to have their food cut up into small pieces and participant’s needs physical assistance from another person to eat and functional and drink. capacity Complex level | Individual support The participant may need to have their food cut of support based on AHP reports |up into small pieces and active, individual support needed and assessments to eat and drink. The participant may need help for Home Enteral Nutrition (HEN) or Percutaneous Endoscopic Gastrostomy (PEG) feeding.
Next steps
For a:
e Plan Approval case, you’ll need to use the home and living calculator to determine the home and living amount. This is entered in the plan conversation support tool to develop the draft budget. To add or update this support in a draft budget, go to article Change the draft budget.
e Plan Change or Participant Budget Update case, go to article Action a budget update.
Article labels — internal use only
PACE user role names
Add:
dc_users_plannerdelegate dc_users_plannernonpartneredarea
dc_users_homeandlivingdelegate
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dc_users_reviewofficer
Topics
Add:
t_evidence
t_housing
t_reasonableandnecessary
t_supportedindependentliving
t_disabilityrelatedhealthsupports
t_planchanges
t_behavioursupport
t_nutrition
t_continence
t_dysphagia
t_homemodifications
t_assistivetechnology
t_specialistdisabilityaccommodation
t_woundandpressurecare
Case names
Add:
dc_case_housingapplication
dc_case_participantbudgetupdate
dc_case_planapproval
dc_case_planchange
Ownership
Add:
own_sgyourplansupportsandimplementation
Version control
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Version Amended Brief Description of Change Status
by
1.0 CS0074 |Class 3 Branch Manager Approval — APPROVED | 2024-10-22 JCO075 |SG and H&L Reform Branch
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