Physical assistance – assist to empower
It’s your birthday! And what better way to spend it than by visiting your favourite restaurant with your nearest and dearest. It smells delicious as the waiter holds the door open for you whilst you enter. You’re taken to your table where the waiter offers to place a napkin over your lap (you decline), before taking your order and leaving you to indulge in your meal of choice. The next day you tell your friend about your pleasant experience. They also recently went to a restaurant; however, they, unfortunately, didn’t have the same experience and inform you of the ordeal they went through. They tell you that their waiter picked them up at the front door and carried them to their table before choosing their meal for them. The experience continued to go awry when the waiter served their meal and proceeded to sit next to them and feed it to them. Whilst the waiter (hopefully) had the best intentions in both scenarios, the level of assistance provided to the person’s friend by the waiter appears to have been excessive for that individual.
We all require different levels of support to help us complete our daily living tasks and whatever life throws in our direction. Whilst I have the capacity to open the door to a restaurant, I will appreciate the gesture if someone wants to do it for me. However, I might find it uncomfortable when a waiter puts a dinner napkin over my lap or fills my glass with water after I drink from it. I don’t need any support with placing a dinner napkin on my lap and whilst I’m unable to walk into the restaurant’s kitchen to fill a jug with water, I’m able to complete aspects of the task independently with the appropriate level of support, such as using the jug to fill my glass if it’s left at my table. These of course are my preferences and will differ from person to person.
Individuals that require increased formal support are more susceptible to encountering challenges when receiving physical assistance – particularly when people overestimate how much help they really need! I asked my participants to list tasks that they enjoy participating in whilst receiving physical assistance, and their pet peeves when it comes to receiving assistance:
- I don’t like it when my supports choose which meal I’m eating without consulting with me when we’re eating out.
- I don’t like it when my supports try to finish my sentences when I’m typing on my communication device.
- Whilst I’m unable to wash my bed sheets without assistance, I like to independently make my bed every morning without support.
- I enjoy participating when my jumper is being put on by my supports by extending my elbows to move my hands through the sleeves of the garment.
- I prefer when my carers adjust the tilt on my powered wheelchair so that I can lean forward instead of them pulling my body forward when putting on T-shirts.
- I currently need support with putting on my ankle foot orthosis (AFO) but prefer to independently put on my Velcro shoes without support.
- I don’t like it when my supports control my powered wheelchair without asking me first.
Physical assistance doesn’t mean that the person is unable to contribute to the task in any meaningful capacity. It often means that they simply require a level of support to complete the task. Unfamiliarity between a person and their support team, as well as time constraints, are common barriers to effective physical assistance that are encountered in practice. Similarly, if supports are not aware of potential assistive technologies they can utilise, they may not be aware of how to provide assistance in the most efficient and empowering way.
Individuals are likely to receive support from a variety of different people throughout their lives, and new carers are naturally going to be less aware of their specific needs. Whilst many positives can come from having a new carer, they may be susceptible to over-assist if they are not fully aware of a person’s capacity to participate. Additionally, people living with a cognitive impairment or intellectual disability may have difficulty communicating their capacity to participate during physical assistance to their new supports. The creation of educational resources, capacity building with supports and advocating for our participants are some of the ways we can improve the familiarity between a carer and their client’s needs.
Time constraints can lead to people feeling the need to cut corners and do everything when supporting someone’s routines because it is easier. A carer rushing to get a resident out of bed and ready for breakfast in a residential care facility or a family member using an attendant-propelled wheelchair instead of a person’s mobility aid to take them to a café are some of many examples where assistance may be provided by supports. Not only is this level of assistance unnecessary, but it is also unhelpful in maximising the individual’s independence. Understanding which tasks a person is happy to complete by themselves, those they need to be completed for them by their supports and those which they want to participate in can work towards reducing excessive assistance. Informal and formal supports can consult the participant or client’s allied health team around strategies that best support their level of function, in line with their overall goals. Allied health can also help link in with assistive technology products, support with task modification and upskill care teams to make certain tasks more achievable.
With these ideas in mind, we want to empower individuals (and their supports) to recognise when they can progress from requiring physical assistance to being able to complete a task with supervision or independently. These strategies will hopefully lead to less reliance on supports and promote greater fulfilment with completing daily activities.
About the author
Carl is a physiotherapist who has a mixed professional background having provided services to adults in residential aged care facilities and in the community through the Home Care Package Program, Department of Veterans Affairs, National Disability Scheme and privately paying clientele. He is a strong advocate for using a holistic approach to providing care and works closely with his clients and their multidisciplinary team to support the achievement of their goals.