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Care Management: Boundaries and Expectations

Boundaries and clear expectations are critical in setting up care in the home and our care managers work at the pace of the client and their support network to ensure engagement from the outset. Communication is key at a time when emotions may be running high and parents in particular need to be on board and understand the role of the care manager.

Danielle Marchant, Care Manager at Bush Care Solutions, shares a recent case where realigning boundaries and expectations allowed a mother to still be mum, whilst keeping her daughter safe.

“When I entered the home, mum was really clear about her desires to take her daughter (22) on an European holiday which included visiting relatives, numerous foreign countries and a full itinerary of accommodation and activities.

“My initial encounters with mum were challenging and these came from a place of expectations and lack of understanding about my role from those who had arranged care and I absolutely understood the place she was coming from. At the same time, my duty was to the client and staff to ensure they were safe and risk was effectively managed.

“My initial role was to work with the parent and explain my role; how I was there to help their daughter safely live a fulfilled life and allow them to be the parents they wanted and still hoped to be despite a significant change in their life. Catastrophic injury changes lives beyond recognition at times and acceptance of new lives can be hard for people.”

With hotels and travel already booked to six countries over the course of two separate weeks, Danielle’s first task (aside from clarifying her role and how she would help) was to assess risk.

“The client’s mother had already selected and booked the hotels she wanted to stay at and their travel arrangements to move between each country including France, Belgium, Germany, Poland and  Latvia. That’s acceptable and we’re not here to take over but no assessment of the accommodation had been done to understand risk and accessibility for the client who had significant care needed..

“The case manager and I contacted every hotel on the itinerary to establish key elements were safe and appropriate for the client – was there an accessible room and bed, where the nearest hospitals and doctors were and so on. We did this in the background to support the family but not control the situation.

“One hotel for example said it was not suitable for wheelchair users at all and confirmed no bathroom access. I took this to mum who, whilst unhappy at first, in time understood the importance and accepted my advice had come from a place of safety.

“It was also important I helped to set clear boundaries for the support workers and there were two on this case. I speak with them about their role on the trip, liaised with the deputy in terms of their pay and agreed how much driving they would have to do and ensured their time was protected where needed. I checked in with them whilst they were away too. 

 “The trip was a success and future trips have now been arranged. Whilst the family enjoyed the holiday, the amount of travelling was difficult for the client and the family now understands the need to work alongside us to ensure all areas of support are risk assessed.”