A hamburger with the lot

Written by Antonio De Maria

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What quality of life are you helping to create for the people you are serving? This question is of top priority in your service delivery.  Sadly, however, this point is especially maligned or ignored in our time of economic rationalism.  So, I wish to raise your consciousness, and challenge you on how you can currently support people.  You need to be committed to the notion that people are entitled to a high quality service, and you need to keep this issue on your agenda. This is not a new topic, but it is one that is often eclipsed by others, and I would like you to think now of the consequences of the values and ethics you show in your service delivery.


I have worked in the Age and Disability Human Service Industry since 1978. I trained as a nurse in one of South Australia’s largest Nursing Homes, then called The Home for Incurables, a name that often drew negative attention. I then furthered my nursing training at Strathmont Centre, a “training” and “accommodation” centre for people with an intellectual disability. For the rest of the two decades I gained more skills and knowledge, for better serving the people I worked with, which involved attending TAFE and University, as well as experiential learning. Today, I continue with ongoing postgraduate studies.


Why have I told you this? Simply because, in order to meet human needs effectively, you have to know what and how the job must be done, and if you work with the most vulnerable people in society you cannot afford to mess with their lives.


Many support workers believe that once they've been taught that is it!  They don’t need to learn any more, or improve their service delivery.  This is a serious situation. It is especially alarming when you consider that there are better-trained hamburger makers than people entrusted with the lives of our family members with a disability.


Care workers should have basic or “key” competencies before they attempt to undertake work.  These enable them to work safely, effectively, competently and ethically. The careworker must be able to provide for:


The Independence of People,

The mobility Needs of People,

The Personal Care Requirements of People,

Health Requirements of People (including support with medication),

The Health and Safety of People,

The Special Nutritional Requirements of People,

The Challenging Behaviour,

The Communication Needs of People,

Support of Community Inclusion,

Working with families,

Facilitating Habilitation of People,

Contributing to Team Outcomes.


While all people you serve are different, and all care workers have specific skill needs, these still remain the most commonly identifiable competencies a worker requires, across the board and across the sector.


Those considering becoming a “professional” care provider may already be aware that there is generally an abundance of work, and those who are “right” for the job will soon realise that they will have that abundance of work. Those who are not may be disappointed they are not getting the hours they want, and probably don't know why.


What makes you the right person for the job?  Depending on who you talk to, you may get a response that sounds like a job description: highly detailed, with a list of criteria such as, Certificate III, Manual Handling, First Aid, Drivers Licence, Cleared Police Checks; while other people might say “someone who cares”.

Actually, both extremes can be ‘right’ and both can miss the point, or not work for the person you serve. I have heard about support workers who were highly trained and heavily credentialled by the agency that had taken them through Certificate III, yet were incapable of meeting the client's needs, and worst still, committed terrible acts of harm on the consumer.




To be the right person, you must have the right Skills.

To be the right person, you must have the right Knowledge

To be the right person, you must have the right Values and Attitudes.



Most of all though, you must integrate all three, and know within yourself that you're the right person.  You need to be honest about this moral and ethical underpinning factor.  If you only have skills and no knowledge of why you do things a certain way, then you're no better than a robot.  If you have lots of knowledge and no skills, that's also useless if the person with a disability requires a high level of practical help, and not just advice.  If you have both knowledge and skills, you're beginning to do well; but if you lack the right “attitudes and values”, you lack the heart and soul for assisting people.  Worse still, your motives may disempower the person, or even worse, devalue them.




People you serve are at Risk,

They may have many service personnel in their life,

You must be of service and not just a service provider in name only.




In a recent conversation with a number of Support Workers, a couple was strongly arguing that they really didn’t need a lot of training to be a Support Worker. They felt all that was needed was to have a kind heart and to be very caring.  So, I raised a number of critical issues with them, one being the point I raised earlier, that:


People who work serving hamburgers are often far better trained than those looking after our relatives in supported care. 


The person serving hamburgers at our favourite franchise take-away generally provides a better quality of service delivery than do many Support Workers looking after our mothers, fathers, grand parents, and aging uncles and aunts.

This raises the uncomfortable question:

To whom are we entrusting the lives of our loved relatives…


And the issue of…

How ethical is it to place people who are called “care workers” or “support workers”, with no or little skills, in possible life and death situations? 


For example, certain clients may be unable to communicate in a way that you can understand, or you may need to assist someone with medication and observe them for side effects which you may not be aware of.


Many situations place a support worker under considerable stress, if they are not adequately prepared for them.  How can that support worker meet such obligations?   Also, how can management justify sending out staff with little or no training, to provide often very complex support to people?  What is the right thing to do? 


In defining ethics and morals, we need to carefully identify what services are delivered ethically, and which ones fall outside this definition.  To many people, the word ethics suggests there are standards that a particular group finds acceptable.  Or, a community may monitor or regulate its behaviour to distinguish acceptable from unacceptable behaviour.  To use this premise, we need to observe the care people are receiving, and how we are doing our job, and ask: Is it acceptable behaviour to continue providing this level of service to our clients, or should we be doing more to assist them to achieve quality of life? 


How do we define quality of life, and what is its connection to the person we are providing a service for?  What do you expect quality of life to be for you, compared to the definition you may impose on the person you are serving?  What is their definition of quality of life? 


This also raises questions on values and attitudes: 

What values do you carry? 

What values do you apply to service delivery? 

What belief systems drive you when you are serving the consumer and their family? 

What is the impact of your attitudes and values on quality of life of that particular person? 


Many people define a value as a concept about things in the world that they perceive as good, desirable or important, and hence they set their entire life to trying to accumulate or achieve the things they view as good, desirable or important.  You may immerse yourself in a lifestyle that you view as desirable and important, and you go on to define it as quality. I challenge you to think about this whole notion of what you value, and how those things in your life compare to the life of a person with a disability or the life of a person who is elderly and has a disability.  Make a comparison.  Consider the abundance in your life of the things you value, and the time you have spent eliminating those things you don’t value.   There's probably a considerable list.  By contrast, there is probably a fairly small list of things in your life that you don’t value, and you are probably working to eliminate those as well.  Now look at the person we call a client.  Look at their life and at their list.  If you take all of the things that you don’t value (and that you work to eliminate from your life), you will probably find an abundance of those very things that you have rejected in their lives.  Similarly, you will probably find they lack those things you value.  For example:


we value privacy, that’s not often there for them,

we value individuality, that’s not often there for them, 

we value respect that’s not often there for them, 

we value being treated as a person, and not as a case or a problem, and often that’s not there for them, 

we value personal development,

we value having meaningful things to do during the day, yet how many people are still doing activities that are not meaningful to them but are meaningful to the therapist or therapy programme.


I call this ‘The Fish John West Rejected Syndrome".

It is the fish John West rejects that usually ends up in the lives of our clients.


We as service providers often fail to value our clients as people.  Also, because we are often so busy and overworked, or because somebody else hasn’t done their job properly before we came on, or we haven’t been trained, or an endless list of other reasons or excuses, we fail to provide the right level of support. This support is critical for the consumer to achieve a quality of life.  While many of us are fortunate to be able to work one to one, I wonder how many opportunities we unconsciously miss to really contribute to the client's personal development. 


At this point, many argue that care workers and support workers don’t get paid enough; that they only get paid to provide production line work.  So, they only provide custodial care to the client: the client, as if on a production line, is taken out of bed and put on a commode; somebody else comes along and bathes them, then hands them over to another, who dresses them, and then somebody else feeds them.

My response is, “we wish”!  Often the standard of care delivered is even far from the quality production line standard that we see, for example, in the car industry. 

Production line workers have to be efficient and effective.  They have to produce and put together quality parts efficiently and effectively, whilst incurring minimum costs and producing maximum outputs and minimum wastage.  That is quality.  So this argument is invalid for us, because the standard in production line work is often associated with quality, albeit impersonal.  What goes on in many organisations, although it may seem like production line work, fails to reach the standards of the mechanistic industry.


This is not a blame issue.  It is about being aware of where we have come from.  We have to continually question what we are doing in the name of service. 


What is of utmost importance to me, is what standard of support will I receive when it's my turn to get these services.  Similarly, what quality of service will you demand when it is your turn?  What will you expect, and will you be happy with?  So, the challenge still remains of defining what we consider is ethical conduct in our service delivery.  By 'us', I refer to service providers, funders, decision-makers, educators and ‘advocates’.  What morals and ethics should be guiding our services to the community? 


Considering we already have some sound pieces of legislation, like the Disability Services Act, the Disability Discrimination Act or the Disability Services Standards, and the Age Care Act, I don’t think we have to look too far.  What we do need to do however, is look very seriously at what has been proposed in this legislation, and ensure we follow in the spirit of its propositions.  We have to stop treating these frameworks as optional.  They are critical.  We must be vigilant about applying these moral and ethical frameworks for our fellow citizens.



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