Respite Caregiver Guide

1. Welcome!

Welcome to the Richmond Society for Community Living (RSCL) Respite Program! We believe adults with developmental disabilities and children with special needs have a right to live full lives in our community. We help them do this by providing services like Respite. Respite gives families a break from their care giving responsibilities and provides opportunities for individuals to grow, make friends, participate, learn, have fun and make choices for themselves. We believe this helps create a more welcoming and inclusive community that can see beyond disability to ability. And that benefits us all.

Respite is funded by the Ministry of Children & Family Development. It is intended to give a break to the people who care for adults with developmental disabilities or children with special needs on a day-to-day basis. This is usually their families, but may be other primary caregivers such as guardians, Supported Living caregivers, foster parents or a representative under Adult Guardianship legislation. In this guide, we call all of these people the families. Successful respite experiences enable families to increase their community networks, have time for personal and emotional maintenance, and maintain or improve their capacity to care for the individual.

The people you provide respite care for are adults with developmental disabilities or children and youth with special needs. In this guide, we call the people receiving respite individuals or consumers. Respite is intended to enhance consumers’ lifestyles through recreational, leisure and community opportunities that support their dignity, self-determination and acceptance in the Richmond community. Activities usually take place in the community, and may include going to the recreation centre or the movies. Respite may take place in your home or the consumer’s home.

Respite arrangements vary widely – depending on the unique needs of the family and individuals you are working with. It can be for a few hours, overnight or a few days at a time. It can be on a regular basis such as every weekend or every Saturday morning, or just occasionally. Whatever your particular arrangement, we thank you for taking on this important role and trust that you will find it a rewarding experience.

2. Why this Guide?

The Respite Program only works because of you. You provide the actual respite care. Our partnership with you is what makes this program a success for the individuals and families it serves.

One of the ways we support our partnership with you is with this guide. It is for you – read it carefully and keep it somewhere where you can refer to it when you need to, and add things to it. It summarizes your obligations, gives practical suggestions and guidelines for a successful respite experience, and includes copies of documents you need to be familiar with. There are also important contact numbers listed on the inside cover, along with space to write in your own. We hope you find it useful, and welcome your suggestions for improving it.

3. Being a Respite Caregiver

Respite caregivers are very special people. You open your home and life to include an individual and their family. In doing so, you get to know this person, and likely their family and/or support network. You will also learn something about yourself. You need to be adaptable, flexible, organized and accepting. You need to be a good problem-solver and communicator who has a sense of humour and likes to learn new things. You also need to take care of yourself, so you do not burn out.

Your role is to provide safe care for the consumer, in an accepting, inclusive environment. You are responsible for the safety, health and well-being of the individual while he or she is in your care, and for making sure that he or she has opportunities to improve social and recreational skills. You are also responsible for communicating with RSCL, the consumer and their family.

We expect you to behave in ways that reflect the inclusive philosophy of RSCL and the Respite Program, and are in keeping with standards that value and respect all individuals equally. Consumers enjoy rights that are to be upheld and respected by everyone involved with them. These are set out in the RSCL Statements on Children’s Rights and Adult Rights that appear as Appendix A at the back of this guide. You should conduct yourself accordingly, and not impose your own personal values or beliefs on the individuals or families you work with.

Every individual has the right to a physically and emotionally safe environment that supports his or her dignity and privacy. The welfare of individuals is of the utmost concern and abuse, neglect or disrespect of any kind is not tolerated. You are expected to dress, speak and act in ways that are respectful and appropriate.

4. What is an Independent Contractor?

Under your contract with RSCL, you are considered an independent contractor, not an RSCL employee. Independent contractors are self-employed individuals. The definition of an independent contractor is determined through several tests. Generally, if you control how, when and where you carry out your duties, use space and equipment that you own, and have a chance to make a profit or loss, you are an independent contractor. The B.C. Employment Standards Branch is responsible for determining who is an independent contractor. If you have questions, refer to their fact sheet in Appendix B at the back of this guide, or contact them at the website listed on the inside cover.

As a contractor, you are covered by RSCL liability insurance for the services you provide. The Supported Living Coordinator can provide you with details of that coverage. You should also consult an insurance professional to ensure you have adequate liability, household, vehicle and other insurance. You are responsible for any damage to your home or property as a result of providing respite care.

You are also responsible for arranging for optional Workers Compensation Board registration, paying all income taxes, employment insurance and CPP premiums and meeting any other statutory requirements. You will be paid on the basis of invoices you submit to RSCL. You will not receive T-4 slips from RSCL and RSCL does not make any remittances to Canada Customs & Revenue Agency on your behalf. If you have questions about your income tax status, we suggest you consult a tax professional or accountant.

You control the specifics of how you deliver the services, within the requirements set out in the contract, and any arrangements made with the family. You must provide your own home, vehicle and other supplies and equipment needed to provide respite, and cannot use RSCL equipment. You are obligated to adhere to the laws of B.C., including the Human Rights Act, the Multiculturalism Act and the Employment Standards Act. More information on all these areas is available from the websites listed on the inside cover of this guide.

5. Your Contractual Obligations

Your contract is the legal document that governs your relationship with RSCL and the services you provide. It overrides everything else, including anything in this guide or anything we may say to you. Be familiar with your contract. Keep a copy handy for easy reference. If you have any questions about what anything in the contract means, you should clarify them before signing, either with RSCL, and/or through independent legal advice.

The purpose of the contract is to set out our mutual obligations, and define who you will provide care for and how much you will be paid. It also sets out the terms under which either you or RSCL may terminate the contract.

For the purposes of the actual provision of respite care; the following is a summary of the key obligations that you must follow:

Participate in the application, interview and orientation process, as defined by RSCL, including a criminal record review and a Ministry Prior Contact Check.
Maintain current CPR and First Aid certification.
Participate in orientation and/or training related to the needs of the individual you will be caring for.
Adhere to routines, goals and specific care standards as set out in the individual’s care plan and health care plans/protocols as applicable.
Follow the behaviour management and critical incident reporting requirements of RSCL and the Ministry of Children & Family Development.
Perform caring functions, including providing a suitable environment and sustaining the individual’s well-being.
Communicate regarding the individual’s needs and interests; involve the individual/family in decision-making affecting the individual; and promote ongoing relationships with the individual’s family/friends/support network.
Document any medical emergencies or critical incidents pertaining to the individual.
Actively promote community and neighbourhood support and involvement.
Provide transportation to planned activities.
Notify RSCL of any change in circumstance that would affect the individual’s safety or well-being.
Treat all information about the individual/family as confidential.
Participate in annual program reviews.
Invoice RSCL regularly for services provided.

RSCL is obligated to:

Provide you with support, assistance, training and advice on matters such as personal care, health, conflict mediation and behaviour management.
Provide up-to-date guidelines regarding the standards of care required.
Screen, approve and support you, the caregiver.
Provide you with pertinent information regarding the individual, including an annually updated care plan.
Act as a liaison between the family, the Ministry and the caregiver.
Monitor the service provided, ensuring that RSCL guidelines are followed.

6. Working with Consumers

The whole point of respite is to give families a break, while promoting community opportunities for the individual. The expected outcomes of the program are:

Families will be satisfied with the respite service;
Individuals will be satisfied with the respite service;
Families will choose their own caregivers;
Caregivers will be available to families;
Newly-served families will receive respite in a timely manner; and
Families will receive an adequate amount of respite.

We are committed to developing and nurturing long term, supportive relationships between caregivers and the consumers and families you work with. The following guidelines will help you in developing these relationships, and in meeting your obligations under the contract.

6.1 Communications

Open and regular communication is the key to a successful family-caregiver relationship. You should communicate with the family about changes in the behaviour or needs of the individual. If you provide overnight respite, you should also communicate about changes in your family or household that could affect the individual. You should discuss how things are going in person and/or by phone or written notes, exchanging information about successes, challenges and incidents. You must be familiar with the individual’s care plan, and communicate about updates and changes to it.

Families are responsible for arranging specific respite times and pick-up/drop-off routines with you, and for giving reasonable notice of any changes. You are also expected to give reasonable notice of any changes. We suggest that you keep a record book showing all bookings and cancellations and the dates and times of care provided. Remember that you cannot provide respite care to more than one consumer at a time, or for more than seven days in a row, without advance approval from the RSCL Supported Living Coordinator.

RSCL facilitates and supports communication in many ways, including offering training, providing resources such as communication books or medication charts, and providing conflict resolution or facilitation if communications have become difficult or there is an issue to be resolved. RSCL also mails out information on a regular basis to both families and caregivers, including program updates, newsletters, and information on professional development and training opportunities. There is a partial list of forms and resources available to caregivers at the back of this guide. Be sure to ask for or suggest others that you think would be helpful in sustaining positive relationships with families and consumers.

6.2 Language

The language you use is important. The perceived value or worth of an individual can be affected by the language used by those around them. For many years, people with disabilities have been identified by their disability first, and as people second. They have often been described as helpless victims to be pitied and cared for, or feared and ignored. Words that are negative, depersonalizing, stereotypical and sometimes offensive have often been used.

It is important to use language, both written and verbal, that enhances dignity and engenders respect for all individuals. Below are some basic principles to follow when talking with and about people with disabilities. You can find more detailed information on the website listed on the front inside cover of this guide.

1. Put people first, and disability second.
Instead of disabled person or defective child, use person with a disability or child with an impairment.

2. Do not use a depersonalized disability or medical diagnosis as a label for a person.
Don’t call people the developmentally disabled, the retarded, the learning disabled, invalids or epileptics. Instead use people who have developmental disabilities, child with a learning disability, someone with a mobility impairment or someone with epilepsy.

3. Use emotionally neutral expressions.
Instead of saying someone is suffering from or afflicted with cerebral palsy, or is a stroke victim, say he or she is a person with cerebral palsy or someone who has had a stroke.

4. Emphasize positive abilities, not limitations.
Don’t say that someone is confined to a wheelchair or housebound. Say that he or she uses a wheelchair or is taught at home. Don’t use terms such as able-bodied or normal in contrast, as they imply that the person with a disability is abnormal.

5. Use words that empower and value people as contributing community members.
Don’t refer to people as family burdens or problems who need placements, case management, and professionals to make decisions for them. Talk about individuals and families who have strengths, support needs, preferences, cultural beliefs and personal goals, and who face challenges.

6. Avoid offensive words.
Words such as cripple, retard, moron, deformed and mongoloid are offensive and derogatory. Use person with a limp, person with a developmental disability or child with Down Syndrome instead.

6.3 Confidentiality & Privacy

Each individual receiving service has the right to have personal information about them treated in confidence. This includes medical, psychological, financial, employment and educational information. This obligation continues indefinitely, even after the respite relationship is over.

In keeping with confidentiality expectations, you should not provide personal or sensitive information about the person you are caring for to people outside their family or RSCL, without written consent. In the case of a minor or an adult who is not making his/her own decisions, this consent must come from the family or legal representative. This includes photos and names, as well as written reports or other information. Keep such information in a private and secure place in your home.

There may be some circumstances in which you have to release information, such as a medical emergency. Ideally, the individual or family should provide the information directly. If this is not possible, share only what is necessary, use appropriate language, and have the advance written permission of the family or RSCL. This requirement does not prevent you from reporting abuse or neglect to the appropriate authorities or cooperating in any subsequent investigations.

6.4 Conflict Resolution

Sometimes differences of opinion or other conflicts arise. The best way to prevent them is through frequent and frank communications. Don’t let little things that are bothering you go by. Be proactive. Bring them up in a non-accusing way, using problem-solving techniques such as:

Always talk to the person you are having the problem with first. Don’t gossip about the problem with others.
Give the person a chance to state their side of the story and try to understand their perspective.
Listen actively and look for ways to resolve the situation.

This can often lead to a simple solution that prevents the problem from becoming bigger and adversely affecting your relationship with the consumer and/or family. Often finding a mutual solution to a difficult situation helps to build trust and strengthen your relationship. If you cannot solve the problem yourself, contact the RSCL Supported Living Coordinator. We can provide conflict resolution support.

6.5 Decision-making

As a caregiver, you are not designated as the legal guardian of the individual you provide respite care for. You should not become involved in the legal, financial or personal affairs of that individual. All consent forms and legal documents must be signed by the individual, parent or legal guardian/representative. An adult can give consent unless he or she has a designated representative. In the case of children and youth under 19, and adults with representatives, only the family or representative can provide consent. However, you may sign as a witness to an individual’s or parent’s signature.

Recent legal changes in B.C. describe the rights of an adult individual to make decisions for themselves, and what happens if he or she needs help making decisions. Individuals are presumed to be capable until legally proven otherwise, and the way a person communicates is not a factor in determining capability. Some adults may have representation agreements, through which they have legally designated someone they trust to help manage their affairs and make personal care, financial, health or legal decisions for them.

Make sure you understand the legal status of any adult you are caring for, and are clear about who can make decisions on their behalf, if they cannot. More information about representation agreements, as well as plain language versions of Take Charge – It’s Your Life! and the Consent to Health Care, are available from RSCL or the Office of the Public Trustee at their website listed on the inside cover of this guide.

6.6 Information About Program and Services

One way you can support the individual and family you work with is by helping to make sure they know about other programs and services for which they may be eligible. RSCL has copies of the Respite program brochure and current information about other government benefits and community programs. Let the Supported Living Coordinator know if you believe that a family or individual needs information about additional supports or services.

6.7 Consumer’s Property

You are expected to respect the personal property of the individual you are caring for. Do not use this property yourself, or allow members of your household to do so. Keep track of the individual’s belongings during the respite visit and return them to the family at pick-up. Keeping an individual’s belongings at your home between respite visits should be done only by arrangement with the family.

6.8 Identification

Families are responsible for making sure that children and adult individuals have appropriate identification and for making sure it accompanies them to and from respite. This could include BCID; B.C. Medical Card; Medic Alert (if applicable); Birth Certificate and/or passport.

6.9 Keeping Records

Caregivers are expected to keep a file for each individual with information needed to provide service and to live up to the obligations of being an independent contractor. This file should include a copy of the most recent care plan, emergency information, a Home to Hospital form and any applicable health care plans and/or protocols. Do not keep highly sensitive personal information in these files once it is no longer needed; forward it to RSCL for retention in the individual’s central file.

For your own protection, we advise that you keep copies of all correspondence with RSCL and the families you serve, and all documentation that you have fulfilled contractual requirements i.e. First Aid certificates etc. Keeping a detailed record book showing all respite arrangements is also a good idea.

6.10 Transportation

You may use your own vehicle to transport the individual you are caring for. You are expected to drive with due care and attention and adhere to all requirements of the Motor Vehicle Act. Never leave an individual unattended in a vehicle and arrange with the family to provide an appropriate car seat if needed.

Vehicle insurance, payment of all traffic fines and costs associated with operating and maintaining the vehicle are solely your responsibility. We recommend that you carry at least $2M in third party liability insurance, and check with an insurance professional about whether you should carry business insurance.

We recommend that you do not take individuals you are caring for out of the lower mainland. If you are going to do so, you must get advance written permission. For children or adults with a representative, this permission must come from the parent/representative. Other adults can provide their own permission. You must also inform RSCL, and carry medical information and emergency numbers with you. If you are crossing into the U.S., you must also have a notarized permission letter from the parent/representative, proof of citizenship for the individual, appropriate medical insurance coverage and medical information and emergency numbers. In the current environment, travel rules for crossing the border may change; check before you leave home.

6.11 Community Inclusion and Advocacy

Part of your role is to help broaden the circle of friends and build new opportunities for the individual you are caring for. Recreational and other community activities should form a part of what you provide. Ideally, this should happen in natural settings in the community, with peers if possible. It can mean swimming at a recreation centre or going horseback riding or to the movies. It may also mean taking a consumer to a regularly planned recreational activity. Families are expected to pay for the costs of admission or participation in such activities.

Respite should not include taking the consumer to professional appointments or providing tutoring. RSCL can provide you with information about community recreational opportunities, as well as any RSCL-sponsored events.

In all of these activities, be aware of the individual’s rights and responsibilities in the community. Stand up for them if you feel they are not being respected and treated with dignity. Support the development of their own self advocacy skills, so they can speak on their own behalf in the wider community.

6.12 Religious Activities

RSCL is a non-denominational organization serving people of all religious beliefs. We encourage and support the right of individuals to freedom of religious choice. As a caregiver, you should respect and support family choices and make reasonable accommodations regarding things such as dietary or moral decisions based on religious belief. Do not take an individual in your care to a religious meeting or event without express family or individual consent.

7. Consumer Health and Well-being

You provide personal care to the individual you care for, develop relationships with them and their families, and form a part of the network of formal and informal supports surrounding that individual. As such, you can become involved in many personal aspects of their lives, and play a role in their overall development. You are responsible for their health and personal well-being while they are in your care.

The key to successfully supporting a consumer during respite stays is to have and follow an up-to-date care plan, as well as any other individual plans or protocols that pertain to their specific situation and needs. The following describes these individual plans, and the various aspects of a consumer’s well-being for which you are responsible while you care for them.

7.1 Personal Plan

Some individuals receiving respite may have a personal plan. A personal plan sets out the dreams, goals and aspirations of an individual, and guides the delivery of all services. It identifies the activities the person will be involved in and who will facilitate or provide them. It is usually developed by RSCL staff or by another agency involved with the individual with input from the consumer and the family/support network. It is reviewed regularly. If the person you are caring for has a personal plan, you may be given a copy of relevant sections and should follow it. It can act as a useful overall guide and context about the individual’s life. You may also be asked to participate in developing or reviewing parts of it that are specific to respite.

7.2 Care Plan

Every individual receiving respite must have a care plan. A care plan describes the assistance and support an individual needs in daily living. It is tailored to reflect the unique preferences and support requirements of each individual. The family usually completes it, with assistance from RSCL if needed. It is a confidential document that contains personal information, and should be treated as such.

A care plan usually contains information such as the following:

Personal and emergency contacts
Description of the person e.g. gifts, talents, likes, dislikes, important issues, triggers for behaviours, potential challenges, significant life experiences
Description of potential risks such as going missing, and Home to Hospital form
Description of personal support network
Personal care and health needs including diet, favourite foods, sleeping patterns, washroom routines, therapies, medical and specialist appointments, medications, allergies, and any other medical concerns
Communication needs and support including preferred learning style and successful teaching strategies
Community involvement including safety protocols when in the community, preferred activities and supports needed

The care plan is a big help to you – it should guide the care you provide. Always have a copy of the plan. Review it and discuss any issues or concerns with the family before providing respite. Care plans are updated by families annually.

7.3 Personal Care

Some individuals need direct assistance with personal care and hygiene routines. You are expected to provide personal care in a way that ensures the privacy and dignity of the individual, and promotes the highest level of independence and personal choice possible. This helps the individual learn appropriate touch, language and personal boundaries through consistent modelling. It also provides comfort, consistency of routine and familiarity for the individual while protecting everyone involved. Do not allow anyone else in your household to provide personal care - only RSCL-approved caregivers are allowed to do so.

Touch and personal interactions are integral components of providing personal care. Make sure you adhere to the following guidelines when touching the individuals you are caring for:

Avoid private parts during affectionate touching or hugging
Allow as much privacy as possible while ensuring safety
Follow the care plan
Let the person feel in control and be able to stop the touching at any time, except in a dangerous situation

7.4 Health Care

You are responsible for meeting the health care needs of the individual you are caring for, as per the care plan. This could include administering prescription and non-prescription medications, using equipment such as braces or a wheelchair, following established routines and instructions regarding feeding, allergies or other medical concerns. Only carry out routines that are set out in writing in the care plan. The care plan includes details about when and how to administer prescription and non-prescription medications and procedures and ramifications of missed doses.

Keep all medications in locked storage, out of reach. If you wish, you can set up a medication chart that includes name of medication, dosage and time, with initials. Ask RSCL for one if you want to use it.

Families are responsible for keeping you informed in writing of any changes to medication or other medical routines, providing you with enough medication (in original containers) or other medical needs for the respite stay, paying all medical expenses and for taking individuals to medical appointments.

7.5 Health Care Plans & Health Care Protocols

A health care plan is required for a consumer with complex health or rehabilitation needs that require professional involvement. It sets out what procedures are required, who can perform them and who monitors them. It includes appropriate protocols such as seizure management, physiotherapy, and/or transfer of nursing functions. For adults, it is developed by Health Services for Community Living Branch of Ministry of Health (HSCL), or by one of their contracted service providers. For children, it is developed by a nurse or other health care professional. If the consumer you are caring for has a health care plan/protocols, you must have a copy of it and follow it. It may be attached to the care plan.

7.6 Behaviour Plans

Some individuals have complex or challenging behavioural needs that require professional involvement. They require a behaviour plan that sets out strategies and interventions to support them in an appropriate and safe way. If the consumer you provide care for has a behaviour plan, make sure you follow it. Contact the RSCL Supported Living Coordinator if you have questions or concerns about it.

7.7 Standard (Universal) Precautions

Caregivers are expected to observe basic cleanliness routines such as regular hand washing, and to understand and follow standard health precautions at all times when providing personal care to an individual. Always treat blood and other bodily fluids as potentially dangerous. Use latex/vinyl gloves when personal care involves blood or other body fluids, or when touching non-intact skin or items/surfaces contaminated with blood or body fluids. Disinfect contaminated surfaces, items and materials with bleach or in the dishwasher or microwave. For more details on standard precautions, check out the website listed on the inside cover of this guide.

For your own protection, you may want to consider immunizations against Hepatitis A, Hepatitis B and influenza. If the individual you are caring for is a carrier of Hepatitis B, you have a right to be notified and we strongly advise you to be immunized. If you choose not to be immunized, we may not consider you as a caregiver for someone who is a Hepatitis B carrier. We also suggest that you do not perform personal care duties. You are responsible for arranging your own immunizations, blood tests and boosters.

7.8 Nutrition

If you provide respite in your own home, you are responsible for meeting the nutritional needs of the individual in your care. Use Canada’s Food Guide as a reference for meal planning. Encourage individuals to make choices within the substitution guidelines of the Food Guide. Follow any nutritional plans and preferences in the care plan, including any food preferences, intolerances or allergies. You are expected to handle food safely, paying particular attention to adequate cooking and refrigeration and to preventing contamination. We strongly encourage you to take a Food Safe course.

For respite provided in the community, families are responsible for providing appropriate snacks or meals or making arrangements to pay for them.

7.9 Sexuality

Sexuality is a natural part of the development and growth of human beings. It is inherent in expressions and perceptions of self. Individuals have the right to learn about and explore their sexuality and sexual identity in developmentally appropriate ways. You should clarify family practices and expectations about things such as appropriate TV shows and videos, touching, and language, and follow those expectations. Do not impose your own moral choices or judgements on the child or individual you are caring for. Inform families of any issues regarding sexuality that arise, and ask for specific training if needed.

7.10 Support During a Hospital Stay

Sometimes you may have to transport or accompany an individual to the hospital, if the family or alternate contacts are not available. If this happens, arrange to meet the RSCL Emergency Response Person at the hospital. In such situations, act as the person’s advocate and support, and provide information to medical staff as required. This may include acting as an interpreter, providing food, personal care and emotional support, assisting with medication administration and liaising with medical staff. You are not allowed to sign consent forms on behalf of the individual or carry out medical or nursing duties such as administering medication or I.V.s, moving the person or changing dressings.

Be aware of the consumer’s rights and dignity while being cared for in the hospital. Advocate on their behalf if needed. Inform RSCL if you have any concerns about the care or treatment the individual received while in hospital. File a critical incident report, including any such concerns.

8. Behaviour Management & Strategies

Caregivers are expected to interact with individuals in valuing and respectful ways that support their rights, safety and dignity. This caring relationship forms the basis for positive and appropriate behaviour. Always strive to assist individuals to develop self-control, self-confidence, self-discipline and sensitivity to their interactions with others. Be familiar with and follow the Ministry of Children & Family Development Guidelines for the Use of Behavioural Techniques that are included as Appendix C at the back of this guide.

Redirection and correction should be a positive learning experience that teaches the child or adult to control and correct his or her own behaviour. It can include natural consequences, praise, encouragement, modeling, rules, limits and counselling. It must not include punishments such as spanking or removal of basic rights such as food or privacy. Positive and preventative strategies that help establish a positive atmosphere can maximize the opportunities for appropriate behaviour. For example:

Establishing clear and consistent expectations and explaining them in a simple, straightforward way
Stating limits in a positive way
Focussing on the behaviour, not the person
Stating what is expected instead of asking questions
Giving time for someone to respond to change
Reinforcing appropriate behaviour with words and gestures
Ignoring minor incidents
Observing and anticipating

Some individuals exhibit challenging behaviours at times. You are expected to use documented behavioural management and intervention techniques designed to reduce behaviours that present risk to the health, safety or well-being of the consumer or others, or limits his or her inclusion in the community. Such strategies must have been approved by the family and set out in an individual’s behaviour plan. The least restrictive strategies are always preferred. Strategies may include verbal or manual guidance, reinforcement, verbal reprimands, time-outs, and in extreme cases physical restraints or seclusion. Only use the latter when an individual is hurting himself or others and as a last resort, never as a punishment or for your own convenience. Document all restraint situations in writing and submit to RSCL within 24 hours.

Techniques that are never permitted include:

Mental or verbal abuse, threats, coercion
Physical punishment e.g. spanking, belt
Electric shock
Noxious substances e.g. Tabasco sauce
Psychotropic drugs without medical authorization
Deprivation of basic human rights such as food, rest, clothing
Orders and demands except in an emergency situation
Ropes, bonds, harnesses
Withholding of visits or family contact
Belittling or ridiculing remarks

We strongly encourage you to access resource materials and training on behaviour management, and to discuss any concerns with the family and RSCL. If you are uncomfortable with a parent’s requests regarding behaviour management, discuss your concerns with RSCL.

9. Safety

When providing care in your own home, you are expected to provide a safe environment, including adequate fire precautions and procedures. This should include fire procedures and regular fire drills, fire safety equipment such as smoke detectors, fire extinguishers and emergency lighting such as a flashlight.

Make sure you have a fully-stocked first aid kit in your home and in your car if you are transporting the individual. Check and restock the kit after every use and at least annually. It should include:

· Antiseptic towelettes (Handi-wipes)

· Band-Aids in various sizes

· Sterile gauze and eye pads

· Gauze roll

· Non-allergenic tape

· Large and small pressure dressings

· Roll crepe tensor bandage

· Triangular bandages

· Scissors

· Tweezers

· Safety pins

· Disposable gloves

· Source of cold (ice pack, frozen peas, chemical cold)

· Mouth shield for CPR (child and adult)

· Protective eye goggles

If you are providing respite in your own home, RSCL staff conduct an initial safety visit and annual safety visits using the RSCL Safety Checklist. This is in order to ensure a safe environment for the consumer. We encourage you to use this list as a regular check and to self-monitor and evaluate the safety of your home environment regularly. There is a copy in Appendix D. For more information on home safety, go to www.safecanada.ca.

10. Emergencies

An emergency is a situation that places an individual or a caregiver at risk, and/or that requires the assistance of a doctor, nurse, 911, or the Ministry of Children & Family Development. Examples include a fire, vehicle accident or earthquake. RSCL has an Emergency Response Procedure including an Emergency Response Person on call 24 hours a day, seven days a week. Contact the RSCL Emergency Response Person in the event of an emergency, at the numbers listed on the inside cover of this guide. He or she will respond and provide support as necessary, and make sure critical incident reports are completed. Call 911 if it is a medical or safety emergency. Contact the family, or designated family emergency contact if the family is not available.

You should be aware of and follow community emergency preparedness plans. We encourage you to follow community guidelines for earthquake preparedness, including having a 72-hour supply of food, water and emergency supplies, and adequate medication or equipment needed to support the individual you are caring for. Check with local Fire Departments and Provincial Emergency Preparedness offices or www.safecanada.ca for more information.

Keep emergency phone numbers for fire, police/ambulance, poison control, and RSCL, along with the consumer’s emergency contact numbers and information, near the phone. Make sure you have a signed consent to transport the individual to hospital and, a completed Home to Hospital form.

11. Critical Incidents

A critical incident is any event that is detrimental to the person being cared for, or to you. This may also include your family members, if you are providing overnight respite. A critical incident is also any event that constitutes an infringement of a consumer’s rights; and/or is unusual or extraordinary in nature. Examples include injury requiring medical attention, suspected or actual abuse, aggressive or unusual behaviour, car accident, poisoning, medication error, exposure to a communicable disease such as Hepatitis B, unusual illness, unexpected death, missing persons, and damage to the caregiver’s home or a public facility. Anything requiring emergency medical, fire or police involvement is considered a critical incident. Critical incidents also include “near-misses” or “close-calls”.

If you witness or are involved with a critical incident, you must contact the consumer’s family and the RSCL Supported Living Coordinator or Emergency Response Person. You must also complete and submit a Critical Incident Report Form within 24 hours. Be familiar with the Ministry of Children and Family Development Guidelines for Reporting Critical Incidents that appear as Appendix E at the back of this guide, and follow them.

You should be prepared for the potential of an individual going missing, and have on hand emergency information for the individual and a list of contacts, family, friends and places the person might go. Consider in advance, in consultation with the family, whether this is an expected risk and what period of time might be considered reasonable before a search would be initiated. Make sure you have a completed Home to Hospital form.

12. Abuse and Neglect

All individuals have the right to an environment that is safe and free from any abuse or neglect. This includes physical, verbal, emotional, financial and sexual abuse as well as active and passive neglect. Examples include:

· Hitting, kicking, slapping or punching

· Use of unreasonable force when disciplining or handling someone

· Isolation or confinement

· Exploitation

· Humiliation or intimidation

· Retaliation

· Withholding of basic care and necessities such a food, clothing, shelter or needed medication

· Fraud regarding an individual’s finances

· Sexual behaviour towards an individual such as touching, obscene gestures, stalking or intercourse.

As a caregiver, you are strictly prohibited from subjecting the person you care for to such abuse or neglect, or from allowing them to be abused or neglected by others while in your care. You are expected to protect those you support from abuse and neglect. Abuse or neglect of a consumer by a caregiver is grounds for immediate termination of the contract, and may also result in future legal action.

If you suspect that an individual you are caring for may have been abused or neglected, you must report it. Follow these steps:

Ensure the immediate safety and well-being of the person.
Notify the police if it is an emergency.
Obtain medical attention if needed.
Notify the RSCL Supported Living Coordinator immediately; after hours, notify the RSCL Emergency Response Person.
Contact the individual’s social worker within 24 hours.
Complete a Critical Incident Report form and return to the RSCL Supported Living Coordinator immediately.
Cooperate fully with any investigation by police and/or the Ministry of Children and Family Development.

It is not your job to notify the family; that is the responsibility of the MCFD social worker.

The law deals differently with abuse and neglect as it applies to adults and to children. The Child, Family and Community Service Act requires that you notify the Ministry of Children and Family Development if you witness or suspect that any child is being abused or neglected, including if a child discloses abuse to you. The Ministry will conduct an investigation, sometimes jointly with the police. The new Adult Guardianship Act now provides for the Office of the Public Trustee to intervene if someone reports that an adult is being abused or neglected. Reports of alleged abuse are usually received by the Ministry of Children & Family Development or a Regional Health Authority.

13. Working with RSCL

As an independent contractor, you are a partner with RSCL in the care of the consumer you work with. We are committed to nurturing that partnership and providing you with the support and training you need to be a successful respite caregiver. Your main contact at RSCL is the Supported Living Coordinator. The Coordinator is responsible for screening, approving and monitoring caregivers, matching and orienting families and caregivers, providing training and support for caregivers, monitoring and evaluating the service, signing contracts and reporting to the Ministry of Children & Family Development.

Here are some tips for making our partnership work:

Communicate regularly with us – let us know at any time if you have any questions or concerns.
Follow our complaint procedure if your concern cannot be resolved informally. You have a right to file a complaint and have it addressed in a professional and prompt manner.
Tell us about your ideas for how to improve the Respite Program.
Take advantage of training, networking and professional development opportunities offered through RSCL and other agencies. Tell us about areas where you would like specific support or resources.

13.1 Monitoring and Evaluation

We are responsible for monitoring the respite service you provide on a regular basis, and for an annual evaluation. We are concerned about both the health, safety and well-being of the consumer, and about your performance in meeting your contractual obligations. You can expect to hear from us periodically, just checking in to see how things are going. You can also expect to hear from us at the time of the annual evaluation, just before contract renewal. At that time, we will ask for the following:

Your participation by completing a program review questionnaire that gives us important feedback about how things are going from your perspective.
A home visit to complete the Safety Checklist, if you provide respite in your home.
A meeting to review the questionnaire, Safety Checklist, any critical incident reports, and any other reports or issues relevant to renewal of your contract.

We will also speak with the family and consumer about their perspective on how things are going. If all is going well, we will then offer to renew our contract and provide you with the updated care plan for the consumer. If there are concerns on our part or on yours, we will try to address them and make changes as needed. The safety and well-being of the consumer is always the most important consideration in our decisions.

14. Taking Care of Yourself

Being a respite caregiver has an impact on you and on the other members of your household. There are many positive benefits and opportunities. There can also be stresses and challenges – physical, mental and emotional. We suggest that you take good care of yourself first, so that you will have the energy to take care of others. There is a practical guide to self-care in Appendix F at the back of this guide – we suggest you read it and use it as a tool to help you understand some of the challenges and feelings you may encounter, and develop strategies to maintain balance in your life.

The following are some other things you should be aware of in order to protect and take care of yourself and make the respite experience a positive one for everyone involved.

14.1 Substance Use (& Abuse)

RSCL supports a healthy, smoke free environment. Caregivers should use common courtesy around people in their care. Specific guidelines for smoking should be mutually agreed upon between you and the family before service begins. These include refraining from smoking in the same room or vehicle as the person being cared for, or smoking only outside or in a designated room.

We understand that social drinking is part of the culture and a commonly accepted practice among many individuals and families. We expect you to conduct yourself in a manner that demonstrates positive role modelling, good judgement and common sense. It is unacceptable for you to be under the influence of substances such as alcohol or illegal drugs. Use of other substances such as prescription or non-prescription medications that could cause impairment is not advised while providing respite.

14.2 Training and Professional Development

One of the best ways to manage any stress is to be open to learning new things and meeting new people. Training events and professional development opportunities can offer new information, new contacts, new ways of meeting challenges, and a sense that you are not the only one dealing with things. RSCL offers such opportunities on a regular basis. We encourage you to participate in them, as well as other opportunities offered in the community. We also encourage you to let us know about issues or subjects that you would like training in. Check out the Training Calendar coming soon to our website at www.rscl.org.

14.3 Violence Prevention

Some consumers may have behaviours that could cause you harm if not appropriately managed. Make sure you are familiar with the Guidelines for Use of Behavioural Techniques at the back of this guide, as well as any issues and strategies about behaviour in the individual’s care plan, behaviour plan and/or health care protocols. We also suggest you take violence prevention training available through RSCL.

14.4 Conflict of Interest

As a caregiver, you could be in a conflict of interest if your self-interest is in conflict with the interests of RSCL and/or the family or individual receiving respite. An example is a respite caregiver selling products to an individual being served. Caregivers should take care to avoid a conflict or apparent conflict of interest situation by:

Not caring for two individuals at the same time, except with advance approval.
Making sure that relatives or others living in your household are not involved in the screening or monitoring of you as a caregiver.
Not selling goods or services or entering into a business relationship with the consumer or family for whom you provide respite.
Making sure that other contracts or employment do not interfere with your ability and availability to provide respite.
Not using RSCL property or services for personal use.

14.5 Additional Employment

You may engage in other contracted work, employment or business activities, provided that it does not interfere with the provision of respite as per your contract and does not constitute a conflict of interest. In carrying out other work, you are not permitted to use RSCL property, equipment or premises, represent RSCL or bring RSCL into disrepute.

14.6 Overnight Care

Sometimes you may provide overnight respite care for an individual. This may be part of your regular arrangement, or an occasional occurrence. Remember that we have to have completed a home study if you are to provide overnight care. Criminal Record Reviews and MCFD Prior Contact Checks are also required for anyone else over the age of 12 who lives in your household. We suggest you refer to the Ministry’s Standards for Foster Homes (children/youth) or Residential Service Standards for People with Developmental Disabilities (adults) for guidance in providing overnight respite care. We can provide you with copies.

14.7 Visitors

In keeping with the goals of the Respite program, and the individual’s care and or personal plan, caregivers should encourage the development of natural support networks and friendships, while at the same time respecting the privacy and choices of the people they care for. When respite is in your home, visitors may be a part of the normal routine. Anyone joining a respite session must be approved in advance by the parent or individual. Overnight visitors must be approved in advance by the RSCL Supported Living Coordinator.

15. A Final Word

In closing, we wish to thank you again for taking on the special job of providing respite care for adults with developmental disabilities or children with special needs. If you have read through to the end of this guide, you are well on your way to being an informed, successful caregiver. We encourage you to use this guide and the other resources we have to offer. Together we can help build a more inclusive community, and support individuals to live fuller lives as citizens of Richmond.