Bill Smith receives a range of 1:1 supports to maintain his routine and equilibrium in order to function and participate in everyday life and to encourage him to develop new and improve existing independent living skills. Supporting his routine and psychological needs requires a strong coordinated effort,led by Bill's mother Mrs Smith, through the team supervisor and Bill's keyworker then on to both experienced, familiar direct supportstaff and new staff.

Bill

Bill is a 25 year old man who has been diagnosed as havinga mental health condition and an intellectual disability. He has lived independently for the last 18 months in a house in Belmontbut receives daily support to ensure that he follows his medication regime and to encourage him to maintain a safe and healthy lifestyle and access his community appropriately. He also receives a considerable amount of support including financial assistance from his mother, Mrs Smith, but she is ageing and experiencing some health issues which is forcing her to reduce the amount of involvement she has with him and support she can provide. Bill's preferred name is Bill. Bill can be challenging to support at times as he has a strong will and often engages in activities or expresses opinions and desires that are difficult to understand or identify motives for. He can be extremely inflexible and demanding at times, particularly around subjects such as taking his medication or engaging in household duties such as cleaning and doing his washing. He will often dismiss reasonable suggestions or requests as "stupid" or, for some reason 'not applicable to him'. For example he will refuse to take his medication unless he has cordial or soft drink to swallow it with, refusing to swallow even a small amount of water as he "can't stand the taste". He will however, occasionally reject a suggestion initially only to consider it at length and change his mind or at least trial the suggested option at a later date. It is important not to give up trying to reason with or persuade Bill to make choices that are more appropriate for his health and wellbeing or financial benefit as more may be achieved than is initially evident.

General presentation:

Bill presents as having the intellectual and social development of a boy in his early teens. He is quiet and withdrawn when meeting strangers and in groups of unfamiliar people but once he is comfortable with someone he can be engaging and display a quirky but entertaining sense of humour. He maintains strong personal boundaries and will speak up if he feels he is being treated unfairly or disrespectfully. If he has a need or want that he sees as high priority, he can become quite loud and overbearing. He is generally polite and can be surprisingly considerate and empathetic but can become demanding and belligerent if his needs and wants are not met to his satisfaction. He tends to have very low motivation except for when he is engaging in activities that he enjoys and has great difficulty in self initiating many of the basic activities of daily life such as housework and cooking.

Personal hygiene:

Bill will often use excessive amounts of bathroom products such as shower gel, shampoo and conditioner, often using a whole bottle in one session. He currently uses tooth paste to wash his hair. This appears to be related to his liking the smell of the tooth paste although he states that it makes his hair soft whereas shampoo and conditioner make it "sticky". He alsooften uses excessive amounts of deodorant and scent products.

Bill uses excessive amounts of toilet paper and will often use so much that he blocks the toilet. He will sometimes forget to wash his hands but usually washes them extremely well.

Billcan make his bed but often sleeps without sheets on his mattress to save himself the effort of doing so. He tends to sleep in his clothes or underwear.

Dressing:

Bill is quite obsessive about his appearance but this can manifest in some unusual ways. He goes through "fads" related to the appearance of his hair and clothing, some of which can be quite outlandish.

He will sometimes change his clothes two or three times a day and will usually add anything he has worn to his washing pile, generating large amounts of washing in a short period of time.

Nutrition and food preparation:

Bill has very poor food safety and preparation skills so he needs lots of support with anything but the most basic food handling. He also has very low literacy and measuring skills so he will often use far too much of some ingredients and has difficulty reading recipes or packet instructions.

He will often leave food out of the refrigerator for too long after cooking it but tends towards throwing food that has been in the fridge away too early rather than using it. His poor literacy/numeracy makes it hard for him to read and understand 'use by' dates.

Bill chooses a very poor quality diet consisting mainly of fried, fast food and sugar loaded soft drinks. He will occasionally eat a healthy meal but his staples are dim sims, potato cakes, lollies chips and chocolate bars washed down with energy drinks and colas. He refuses to drink water as he "doesn't like the taste". He regards energy drinks as essential and will sometimes drink three or four of the largest cans available in a day despite being aware of the manufacturer's suggested maximum intake. He is very resistant to suggestion that he change his diet despite his rapid weight gain over the last 10 years and his poor state of general health.

Bill can cook simple meals, usually opting for pre pre-prepared or "packet" foods such as instant noodles or tinned soups. He can operate a stove and use an oven but needs support with temperatures and remembering to turn things off.

Personal safety:

Bill needs considerable support with any emergency as he becomes easily panicked and has a poor grasp of emergency response procedures. He has a basic knowledge of fire and electrical safety but will often disregard hazards to suit his own convenience or priorities. For example, he will oftenuse flammable containers, such as cardboard packets, as ashtrays and balance electrical equipment precariously or position containers of liquid such as indoor water features where they are likely to spill or splash onto power points or plug boards.

Domestic hygiene:

Bill knows how to undertake most household cleaning tasks but will often put them off until the situation becomes chronic. He avoids cleaning his toilet and bath room and will ignore the condition of his bath, shower and basin for weeks unless he is motivated by a strong incentive such as expecting visitors.

Bill will clean up spills in his kitchen or in the fridge however, hewill avoid routine cleaning of surfaces and would be unlikely to notice a gradual build-up of dirt or mould.

We are currently working on Bill learning to use his bins appropriately after having had collection of his recycling bin refused as it was full of general rubbish and food scraps.

Bill usually refuses to take part in any outdoor maintenance regardless of his awareness of it being necessary. He will usually find reasons to avoid doing it and ask others to do it for him.

Bill will allow his washing to build up unless he is prompted and motivated to do it. He will often wash inappropriate items together and will sometimes wash a load of clothes two or three times "to make sure they are properly clean". He will usually use excessive amounts of powder.

Bill will sort and fold clothes to put them away given suitable motivation but prefers to store them in piles on the lounge room furniture.

Budgeting and finances:

Bill has great difficulty managing his money. He relies on his mother heavily to substitute his income and spends large sums on items that he doesn't need, leaving him short of money for essentials like food and cleaning products. His poor numeracy skills and inappropriate priorities make it unlikely that he would be able to create or follow any kind of budget. He can save for a large item such as a new bike and identify when he has accumulated the required amount but sees household shopping, bills and rent as something that other people will take care of for him. Bill lives with a minimum of planning, except where it involves areas he regards as high priority, so he will overstock on items he values and understock on essentials. He can develop a shopping list but is likely to make last minute decisions that negate the purpose. He will estimate the total value of his shop then take items back if the register total is more than he can afford.

Bill understands the value of notes and coins but has poor maths skills so he often needs support making calculations. He can count his change but has some difficulty doing this accurately in a short space of time and will often make mistakes. He can also use an ATM but often needs support to make selections from the menu due to his poor literacy.

Social interaction:

Bill's behaviour toward others is often driven by his priorities so, while he is usually generous, considerate and polite, he can be extremely inconsiderate, aggressively demanding and rude, often coming across as impatient and belligerent. This has an impact on his ability to maintain relationships and make friends.

Bill will often blame his mistakes and inappropriate actions on others or simply deny them. He places his own wants as his highest priority most of the time which can have a significant impact on his reliability and trustworthiness.

Bill is fairly uncomfortable in social situations except with his family and closest friends so he is unlikely to join in with an activity if it involves interacting with anyone other than members of this group.

Health and medication:

Bill will often refuse to take or forget to take his medication and has little understanding of the reasons for his regular medication. He is able to identify when he is unwell but is likely to either under or overestimate the severity of his illness depending on how it impacts his normal level of functioning and how much pain it causes. He would require some level of support to makeand attend an appointment with a doctor or specialist, use of 'over the counter' medications or with getting a prescription filled.

Recreation:

Billenjoys passive recreation, listening to music and watching movies. In the past he was a keen fisherman and built and rode push bikes, even building motorised push bikes, but his health has declined to a point where he finds it hard to walk or ride more than a very short distance without becoming tired and short of breath. Although he is still enthusiastic about the theory of some of the activities he used to engage in regularly, he tires so quickly that he finds practicing them extremely challenging and tends to choose to either disengage after a short period or not to engage at all. He is quite an experienced cycle mechanic but rarely works on bikes since his ability to ride them has declined to the point where he has almost completely lost the motivation to do so. Bill does enjoy swimming at the local pool and this is currently one of the few physical activities he will happily engage in for any length of time.

Conclusion

It is important for staff supporting Bill to be resilient, creative and flexible. They should be able to set and maintain firm boundaries and not give up on encouraging Bill to consider making changes to his lifestyle, habits and preferences that will have both short and long term beneficial effects on his wellbeing and financial situation. Staff need to look for opportunities and a variety of ways to motivate and encourage Bill to engage and participate in activities and to make choices that improve his finances, health, safety and wellbeing.

Bill is slowly progressing towards a greater level of independence and responsibility but needs constant reassurance and motivation to encourage him to maintain this progress. It is important to provide positive feedback whenever it is warranted and to regularly and repetitively suggest that he consider more positive options to some of his less appropriate choices, habits and preferences.

Bill's Support Goals

Q1

The things that are most important to Bill when supporting Bill are?

Q2

What are the supports received by Bill from organisation?

Q3

Essential Supports that help Bill stay healthy and safe are?

Q4

Suggestions and other things Bill need support with if staff have extra time?

Q5

Equipment/Technological/Communication Needs?

Q6

Any specific/special Training required to support Bill?

Q7

Things support staff need to know about Bill?

Q8

Helpful Information things we need to learn. Action Planning Goals for Bill?

Question 9a

Describe the process of putting the plan together with Bill. List three of the client's needs that has been addressed in the plan?

Question 9b

How does one ensure these needs could be met?

Question 9c

What resources will you require to fulfil these needs?

Question 9d

Describe how the client participated in the development of the plan. For instance, did they give suggestions or did you need to prompt them?

Question 10a

Discuss the involvement of other people and / or organisations in fulfilling the client's plan. Who else may need to be involved in the creation of the client's plan?

Question 10b

Which other workers or agencies may you need to engage to provide services to fulfil the client's plan?

Question 10c

What procedures / legislations are you required to follow when seeking support from other agencies to maintain your client's privacy?