Neurorehabilitation and COVID-19 – a 360 degree view of the sector – episode 5

The COVID-19 pandemic is affecting all aspects of the world of neurorehabilitation, with people and businesses working within it turning to innovative new ways of working to protect and support clients.

Here, in the latest insight brought to you by the neurotrauma team at Sintons, Jane Paige and Ella Cornforth, of Northern Lifetime, discuss their efforts to adapt to the unprecedented situation while maintaining the care their clients need.

Building trusting relationships with clients is absolutely fundamental to case management and that is certainly being tested at the minute with the unprecedented circumstances of COVID-19.

The care and support our clients receive will always be paramount for us, and since the social distancing measures began to be introduced, and then lockdown was enforced, we have had to be very creative and flexible in our responses. Although the business has been around for a number of years, we only joined six months ago , so this was a huge unforeseen challenge very early into our journey, but thankfully we have many years of experience of working in case management and have a strong team who are committed to adapting to this ever-changing situation.

We keep telling ourselves these are unprecedented times, there is no rule book, no-one knows what is going to happen, so we can only respond as best we can. No two days are ever the same in case management anyway, so we are viewing this as the latest challenge to get through. We are building as much supportive scaffolding around our clients as possible, so we can get through the weeks and months ahead together.

In the first week of lockdown, one of our clients had two of their staff go into self-isolation, which meant we had to respond very rapidly to ensure their usual care provision was maintained. We have also had to change traditional shift patterns in many instances to accommodate absence – whereas usually there may have been a day and night shift, now we look at what resource we have available and make provision from there. We may risk assess whether a person can manage on their own for short periods of time, and with some of the child clients we have, their parents have opted to play a greater role in their care and dispensed with paid carers altogether. This, however, needs careful monitoring.

Agencies are being very dynamic, and there are many agency staff available should we need them, but that is not always something that is welcomed by our clients, who don’t want new people coming into their homes. Some people have chosen to go into self isolation, which is working well for now, but we will continue to evaluate their situations. At some point, they may need additional help, but it depends entirely on the client and their circumstances. Every situation is wholly different, and can change by the day, which is challenging in itself.

Building a routine for our clients is very important. Whereas previously they may have had a club they attended twice a week, that has gone now, with nothing to replace it. We are working with other agencies to ensure they continue to have some structure, as that is very important for people with brain injuries. It might be the case that the once-a-month session with their psychiatrist can be broken down into shorter twice-a-week sessions, so they have that regularity of contact. Even building walking the dog into the daily routine can give some kind of structure, and can offer a form of activity that gives a sense of purpose.

We also miss the communication we have with each other. While we work across the country and will speak to each other every day, we would see each other at least once a week and that’s a very important opportunity for us to offload. Case management is an emotionally and psychologically challenging job, one which we love, but that human contact with each other is hard to replicate via video.

That is the case in dealing with our clients, too. While many are getting used to it because they have to, it’s far from ideal for the role we play and we both feel our clients are missing out by not having face to face contact. There is something very powerful about sitting down with someone, having a cup of tea with them, chatting through what’s happening in their world. They might have barriers up that we have to find ways to break down, perhaps they’ve had a bad experience with a medical or care professional previously and are not going to trust easily, so they are harder to engage. That process is even more difficult when you can’t even be in the same room.

We spoke to someone last week on video call and couldn’t see she was crying until she wiped her eyes. You can’t see the little cues and gestures that you would be able to if you were sitting down with them, and that is very difficult. If we have someone in distress then ordinarily we can say ‘Let me come and see you and we’ll chat’ but we cannot be as comforting when you have to communicate by phone or video. Clients are trying to adapt to using this form of communication but it is very challenging for them to hold meetings in this way, and can contribute to their cognitive fatigue. We are well versed in investing the time and effort to build relationships with clients, often in creative ways. That may come in the first instance from engaging through looking at photos on their wall, the fact they have a dog, the fact they have children – one client, who was particularly difficult to engage, would only open up when we went for long walks with his dogs. These are very people-centred communications which we are really missing.

Our concern is that this new-found reliance on technology may become the ‘new normal’. As many benefits as it does have – for example, we now have a WhatsApp group among our team, which is a great additional way of communicating and keeping in touch on client matters, although never as a substitute for the formal paperwork and evidence – it can never replace the power of face-to-face interaction for us and the way we work. We may be called old fashioned, but our years of experience in case management have shown us time and again that this is how relationships are built and trust is gained. Nothing can replace that for us and as soon as we are allowed, we will be back out there, seeing our clients.

We will get through this pandemic and will continue to focus on ‘making the most of life’, which is our company strapline. When we come out of the other side, we will look back and reflect on what an achievement it was to get through these enormously difficult times and know that we can get through anything, whatever the next challenge may be.

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