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 Volume 5 Issue 4 - Spring 1999 A Publication of the TRIC/PLUK Library Editor/Librarian: LeeAnn Logan/Janice Sand |
TRIC/PLUK Library 516 N 32nd St Billings, MT 59101-6003 1-800-222-7585 in MT 406-255-0540 (voice/TT) FAX: 406-255-0523 E-mail: plukinfo@pluk.org URL: http://www.pluk.org |
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EMERGENCY EVACUATION PLANS -- RESIDENCES
--by Brad Johnson, DDP 321 E Main Suite 424 Bozeman, MT 59715
A good, well thought out and rehearsed evacuation plan is a must for all facilities but it is especially crucial in residential facilities (group homes, apartments, institutions, and family homes). The two main reasons for this is that individuals may be sleeping and there is usually less staff available to assist in an emergency.
The key is to have a plan. This is a lot more complex than one might think. The plan needs to include variances for the different levels of staffing, location of the emergency and weather. The plan needs to address the following: 1) recognition of the emergency; 2) notification of emergency services providers; 3) action to be taken to reduce the emergency; 4) actual evacuation plan; 5) follow-up plan; and 6) special situations and considerations.
Recognition of the Emergency &endash; What is happening? Is the smoke detector sounding or is it the carbon monoxide (CO) detector? (Evacuations relating to earthquakes, floods and inclement weather will be dealt with in future articles. Both require immediate evacuation.) Where is the fire located or where is the smoke coming from? How big is it? These are questions a person needs to answer very quickly in making decisions about what to do. Another consideration that should be addressed is that when caregivers are asleep, are they able to have access to clothing that is put on quickly so that they can respond in a rapid fashion. Clothing that is easy to put on might include slip-on shoes, sweat pants and a pullover shirt. A caregiver's ability to function may be severely hampered if trying to evacuate a group of people in -20 degree weather with bare feet.
Notification of Emergency Services Providers &endash; Decision time again. Do I have time to notify emergency services providers (911)? In most situations, it is better to simply call in the emergency and then check out the problem. Fire trucks can always be turned around. If there is any doubt, however, evacuate first and notify later. Plan, Plan, Plan.
Action to be Taken to Reduce the Emergency &endash; We have fire extinguishers available and provide training on them for the purpose of extinguishing small fires. Smoke detectors are very sensitive and usually give very advanced warning. Often-times, simply putting out the fire is the best way to reduce the emergency. You may still need to evacuate due to a contaminated atmosphere. There is no action that you can take to reduce a CO emergency except to simply evacuate. Again, when in doubt, always evacuate first.
Actual Evacuation Plan &endash; The plan must be thought out, detailed, written down, and rehearsed. As an example, I'll use a group home having 6 individuals with low self-help needs (two in wheelchairs) with one awake night staff person. Each person has his or her own bedroom. There is one wing for the bedrooms that has a door separating it from the rest of the residence. The primary plan is that the staff person will isolate the sleeping area from the rest of the house, wake up those not already awake and moving out the rear door, move each wheelchair person out the rear door while escorting the others ahead of him. Once out the door to the outside, the staff person will then move everyone to the van, start it and move it away from the residence. The plan for this home is detailed enough that there is a specific spot for each wheelchair after the person is in bed, a specific spot for the Hoyer lift at night, a specific order for each person to be assisted and a secondary plan for in the event the fire starts in the sleeping area. (Details must be thorough: Where is the van key going to be? Where is the house key? It would be tragic if the door closed and locked behind the caregiver and they could not get back in to assist the rest of the group.)
Follow-up Plan &endash; Once the home is evacuated, what next? (Note: if at all possible, someone needs to meet the emergency personnel when they arrive to let them know if everyone is out of the house or not.) Some plans include going to a meeting place, group home van or bus, or to another residence. Further follow-up includes planning for where to go for the next hour, six hours, 24 hours, week… This includes getting to a warm, safe place, notifying supervisory staff and requesting back up staff for relief. Tenants with intensive needs must have significant planning for the possibility that they may not be able to return to their residence for some time. Simply going to a motel will not meet their needs.
Special Situations and Considerations &endash; Changes in tenants need to be noted as part of an evacuation plan. An example would be a residence where everyone is normally ambulatory but now one person has his or her leg in a non-weight bearing cast for three months. The evacuation plan needs to be temporarily modified for this and communicated to all the responsible caregivers on each shift. Persons on oxygen will need a special plan; tenants who are blind or deaf have varying needs. If the van is part of the plan but in the shop, a back-up van should be obtained. Always adapt the plan as needed, even if it is only for that one night. Having served in the fire service for over twenty years, I am a firm believer in Murphy's Law. It's going to happen on that night you don't plan for it.
In conclusion, an evacuation plan is not a static policy or procedure but a dynamic tool for ensuring the health and safety of those we serve. It may even save a life.•••
POISE UNDER PRESSURE -- (Part One)
INDICATORS OF ABUSE
-- by Lori Wertz and Novelene Martin, Abuse Prevention Specialists
Human Services is unique in one regard: behavior that would normally be regarded as offensive or as a violation of our individual and civil rights can be a daily occurrence at work. We are told that we WILL provide good care, we WILL NOT lose our tempers, we WILL NOT react to insults, non-compliance, or personal attacks. Why? Because it is policy, it is law. In the end, we will be Sainted, or at least we hope so, because we certainly aren't doing all of this for the millions of dollars in our paychecks!
According to Roger MacNamara of Abuse Prevention Specialists, there are four major indicators of abuse that can be readily observed in any environment. These four indicators may stand alone, or may be interlocked much like a puzzle. If left unchecked, these indicators can feed one another and will most certainly escalate into abuse.
The first of the four indicators is the "power struggle". We all know about them&emdash;they are generally our own response to a given set of circumstances. Haven't you ever had one of those days when everyone seems to be riding your last nerve? How about feeling like someone's head needs to roll&emdash;you just can't stand one more complaint, concern or constructive criticism? Haven't you ever just felt the need to blow up and get it off your chest? The all too familiar power struggle develops when we respond emotionally, resort to a confrontational style of doing business, have unrealistic or false expectations of the person or situation, and maybe more often, when we think we can win!
What do I do if I see a co-worker engaging in a power struggle? Try redirecting your friend/co-worker. "How about if I try for awhile?" Develop a "code word" for staff to use when getting into or observing a power struggle.
What if I am getting into a power struggle and I'm on my own? Stop, step back, take a deep breath, and think. Don't try to solve everything at once. Do develop an anger management strategy.
The second indicator is "negative responses to upset individuals." We know that when we respond to an individual, our approach can either diffuse or escalate a situation. Sometimes maybe we are just too tired, too distracted or too rushed to deal with the person right now. Yet, we have all worked with individual employees who always seem to have a "magic touch" to difficult events or people. What makes them so different from the rest of us? How do they maintain their poise, their self control, their ability to remain calm? It isn't an accident. It's called being emotionally responsible and we hope to talk about it in the next issue of Quality Matters.
What do I do if I have a client that just makes me craaaaazy!!!? See if there is someone who works better or isn't bothered by that person. Identifying our own inability to work with certain people is a strength! Talk to your supervisor&emdash;maybe someone else out there has a similar problem and you can switch!
The third indicator of abuse relates specifically to "behavior management plans which focus on consequences". It becomes all too easy for caregivers to use these types of behavior plans to "behavior hunt" or focus entirely on the individual's behavior. IP teams can be caught in the same web where the individual is no longer seen as a valued person but rather as "the behavior". Ultimately and unintentionally, often with apparent IP team sanction, this can cause staff to take on the role of an "enforcer" which can result in a punishment mentality or in unnecessary confrontation and compliance.
What do I do instead of consequences? Look at why the behavior is occurring. What can we do differently when the behavior does occur? What factors in the environment are contributing to the behavior (staff interactions, boredom, lack of respect)? What can I teach the person instead? Focus on how to help the person rather than how to eliminate the behavior.
The fourth indicator of abuse is "defective supervision". How often do we see our supervisors? When we do see them, what kind of interactions do they have with us? If a supervisor isn't readily available to staff, if he/she is not able to identify and address stressors in an environment, if staff feel threatened or dictated to in their workplace&emdash;abuse will occur. A good supervisor needs to be ever vigilant, needs to gently correct missteps along the way, needs to teach and to collaborate, praise and evaluate&emdash;in short, needs to be a master caregiver and a model of support for both staff and clients.
What do I with defective supervision? I never see my supervisor and when I do, s/he only tells me about everything we did wrong. Is it possible that your supervisor doesn't realize this is how s/he is percieved? If talking to him/her directly doesn't help, or isn't possible, is there someone else you can discuss this with who can effect a change? Try telling your supervisor what s/he has done well&emdash;positive reinforcement is a two way street!
These four indicators of abuse are present to some degree in any environment&emdash;our workplaces, our homes, the local grocery store. They are part of every relationship we have whether it is a professional/work relationship, interactions with our spouses, our children, or our parents. If the indicators exist in all environments, then abuse is possible in all environments.
Abuse has a look, a taste, a feel and a sound. It is sometimes more subtle than bruises or screams. It is often more insidious than blatant, reportable acts of aggression. Often, as staff persons, we can become desensitized to it. The four indicators of abuse act as antecedents to abusive behavior and of themselves, may not be stictly reportable in terms of Adult Protective Services. They are however, issues that should come up between staff people, with Directors and Supervisors, and maybe with Individual Planning Teams. It is our responsibility as caregivers to identify these indicators and eliminate them from our environments. If each of us makes the pledge to be vigilant and to not accept less than what we know to be excellence in caregiving, we can and will prevent abuse.
For more information about Abuse Prevention Specialists, or for possible training in your area, please contact your Regional DD Office, or call Novelene (232-2595) or Lori (454-6094).•••
QUALITY CORNER
DD Case Managers: If you have things to add to this section, please send them to me. I will compile, edit, and send articles and information on to Lee Ann. Contact: James Driggers at (406) 444-2995.
Aspartame
An article was recently circulated over the Internet that made some rather sensational claims about the dangers of Aspartame (NutraSweet). We got calls from a couple of case managers about the article, since so many of us drink lots of diet pop. Dan Cleveland followed up with Bill Docktor, who reviewed a collection of material about Aspartame. The flavor of the information he reviewed is that there is little support in scientific literature for the claims in the article which was circulated. He says, "At this point I don't intend to stop drinking Diet Coke."
Diana Spas (Ted's wife) from the Rural Institute also researched the topic on the Internet and reached the same conclusion as Dr. Docktor. Just thought you would like to know.
Adult Foster Care Law Change
The Adult Foster Care law change that was mentioned in the last Quality Corner has been signed by the governor. The change would permit an adult foster license to be granted in situations where people live who are receiving DDP-FUNDED services and who previously would not have been licensable due to inability to self-evacuate, incontinence, or inability to self-administer medications. This will create a viable option for a few individuals in services that has not been available before.
Companionship Law Change
Also of interest to people in supported living situations, companionship legislation has been signed by the governor which will exempt people who provide companionship services from minimum wage and overtime requirements. This will make paid roommate situations much easier to arrange and implement, since the roommate can serve as a "companion," rather than being required to receive minimum wage and overtime for time worked. The law change will enable people to negotiate a wide range of arrangements with paid roommates.
A companion is defined by the Fair Labor Standards Act as "any employee employed on a casual basis in domestic services providing companionship for individuals who, because of advanced age or physical or mental infirmity, are unable to care for themselves." A companion provides fellowship, care, and protection for a person who cannot care for his or her own needs. It includes household tasks related to the care of the consumer, such as meal preparation, bed making, clothes washing, and other similar services. •••
New Library Materials
Special Needs Transportation Handbook&endash;by Ray Turner (1998). This is a very comprehensive and practical guide to help transport students with disabilities. It is an excellent source for training special needs drivers and assistants.
PBS&endash;Putting the Positive Into Behavioral Support: An Introductory Training Packet&endash; by Ruef, Poston and Humphrey (1998). This manual is to be used to present awareness level training on positive behavioral support to parents, teachers, and direct service providers. The activities and examples are drawn from research and personal experience and from best practices in positive behavioral support. They have been field tested by parent groups, teachers, and service providers.
Choosing A Wheelchair: A Guide For Optimal Independence&endash;by Gary Karp (1998). This book is written for first-time and experienced chair users who need to replace their current wheelchair. Karp, an ergonomics consultant and wheelchair user, takes the reader through the selection process, discussing issues to consider when buying a chair including payment options. The guide empowers people with disabilities to make an informed equipement choice.
Challenge to Independence: Vision and Hearing Loss Among Older Adults&endash;by Boone, Watson, and Bagley (1994). This monograph brings together a wide range of information about age-related hearing and vision loss acquired in late life.
It's All Part Of The Job: Social Skills for Success at Work&endash;(1993). This video features real life workers with developmental disabilities and their employers. It focuses on the social skills needed to succeed on the job such as personal appearance, getting to work on time, getting along with co-workers, following directions and staying on task.•••
Copyright © 1999 Parents, Let's Unite for Kids, all rights reserved.