Leading Practice Guidelines

Health Care Support

Type: Wellbeing

Guideline: Organizations provide the support and assistance needed for each person to be as healthy as possible or desired and live a healthy lifestyle of their design. Support includes provision of information, assistance with accessing required health care providers, assistance with health advocacy, promotion of healthy choices, assistance with obtaining recommended and timely preventative health screening, and creating and maintaining systems and ability to respond to health emergencies.

What does this look like?

The organization has comprehensive systems and practices that provide individualized health care supports to each person. These will include:

1. Gather/Document/Plan
   • The organization collects and documents relevant health history, risk factors, conditions and health care needs of each person served. This is done preferably prior to the person being served by the organization and on an ongoing basis. This information may be collected from the person, their family, support network members, previous service providers, health care professionals or others as identified. This information is documented in a plan that is accessible to those that require it to support the person, with their consent.
   • The organization gathers and documents information from the person and those that support them, on what support the person requires to manage their health care, documents any specific wishes or preferences they have regarding health care and ensures that these instructions are available and known by all who require this information. This should also include supports the person may need to communicate effectively with health care professionals (augmentative communication, interpretation, support staff, etc.)
   • The organization ensures there is a system to collect health observations and notes on a daily basis. This system collects observations about symptom onset and details, minor illness occurrences and other relevant health information.
2. Access/Provide
   • People have access to and are assisted to maintain a relationship with a primary care physician or other suitably qualified health practitioner of their choice.
   • The organization has a system and practice that supports people to access their health care providers as needed. This may include arranging the logistics of setting up appointments, getting to and from, providing support during a health appointment, etc.
   • If the person requires support during health appointments, the organization will arrange that a qualified person who knows the person well, understands his/her health issues, and who can communicate with the primary health care provider, attends the appointment, documents what occurs and does appropriate follow up. This person may attend along with or instead of family/designated members of the person’s support network.
   • The organization assists each person to obtain a thorough annual physical with their primary health care provider, along with other health screenings and treatments guided by the Canadian Consensus Guidelines on primary care for adults with intellectual and developmental disabilities (see resources) (e.g. 6 monthly dental check, annual influenza vaccinations, annual/biannual hearing and vision/eye health checks).
   • Medications should be reviewed annually by a doctor or pharmacist to be sure that they remain appropriate and the full list can be reviewed for contraindications.
   • The organization seeks out required support for people who may experience limitations to mobility or movement. This may include access to and input from physiotherapy and occupational therapy as required. Consultation required may include consultation on seating, night and daytime positioning systems, the use of equipment e.g. wheelchair, standing frames, orthotics, pressure relieving equipment etc.
3. Implement & Follow up
   • The organization has a system for tracking or monitoring health outcomes of recommendations made by a health care provider for assessments, treatment, and other services.
   • Routine monitoring or observations are done to prevent or ensure early detection of chronic or common health concerns for each person.
4. Communication
   • The organization manages communication and coordination between health care professionals and systems, communicating with physicians, dentists, and other health care providers as required.
   • The organization provides timely sharing of information with the person, substitute decision maker (SDM), family, support network and other organizations involved in supporting the person as appropriate and guided by the person. This information should be provided in a manner that is accessible to the recipient in order to facilitate full understanding.
   • The organization ensures that the person is supported to advocate or advocates on their behalf as needed when gaps or challenges occur in accessing quality health care.
   • The organization has a robust and thorough system to communicate changes in health care status, treatments, medications or instructions to all staff who need to be aware of this information.
   • Where organizations have limits to the types of health supports that they would provide or coordinate, this is communicated to the person, their SDM and their support network, whenever possible in advance of services starting.
   • People are encouraged and assisted to access appropriate health information and education in the community including information on:
     • diet and nutrition
     • the risks associated with smoking, alcohol and drug consumption
     • exercise and physical activity
     • other relevant health related topics important to and for the person.
5. Training
   • Staff receive high quality training and competency assessment in all aspects of the physical and psychological needs of the people being supported.
   • Staff receive training and information on universal precautions and infection control and there is evidence of effective infection prevention and control measures in place.

How would you know this is happening? (Evidence)

What you see in systems:

• Written policies and procedures are available that outline the expectations of behaviour of staff as it relates to supporting health care.
• People’s records include documentation of relevant health history, risk factors, conditions and health care needs including the supports that they require to be as independent as possible in managing their own health care.
• Staff training details expectations, behaviour and practices required to support people to be as healthy as possible. Records are maintained of competency and completion.

What you see in actions:

• Staff have a good awareness of what is ‘usual’ for the person in terms of their health and wellbeing, and are able to identify and respond swiftly to indicators of changes in health status (physical or psychological/emotional and mental health).
• Staff are aware of how an individual communicates their health needs, including indicators of discomfort, pain or distress – and are responsive to these communications.
• People and their family/support network feel involved, informed, and educated on what they need to do to be as healthy as possible and have access to supports required. This includes receiving training, support, and the opportunity to practice what to do in the case of a medical emergency.