Making a decision

Making a decision

Here are some questions you can consider when making a decision about whether or not a two person service is needed?

The Decision Checklist allows you to document and print your decision.

Why is this necessary?

    1. A two Support Worker service may be necessary in order to meet the needs of the Participant.

    2. It may also be necessary to meet the needs of the Participant and the Support Workers if an adequately safe alternative cannot be found or cannot be realized in a timely manner.

    Will it achieve what we want?

    1. If the Participant’s needs are met, it may achieve your aims.

    2. If you seek a safer service for the Participant and your Support Workers, then this is one option of how you might achieve that.

    3. You should still look at alternatives to make the service safer because a two Support Worker service is not a substitute for a safe workplace.

    How can I keep service costs down?

    1. Sometimes only a portion or portions of a service require a second Support Worker. One option is to schedule the second Support Worker to only join the service at a specific point of the service e.g. transfer bed to wheelchair.

    2. Sometimes a second Support Worker is required different times during a service e.g. transfer bed to commode chair, after shower transfer commode to bed, assist with in bed drying and dressing and then transfer bed to wheelchair. If possible, assign other service tasks to the second Support Worker e.g. housekeeping, until their assistance is required.

Is this a temporary or permanent adjustment?

    1. Ideally, a two Support Worker service is temporary until planned changes to the service can be realized e.g. referral to Occupational Therapy for equipment prescription, equipment arrives; Minor bathroom modifications occur; a behavioural management plan is created and implemented.

    2. Sometimes even after changes to the service are realized there remains a need for a second Support Worker in order to either maintain the level of quality care or to keep the Participant and/ or Care Worker safe. Examples of when this might occur: The Participant’s condition continues to deteriorate and they are too stiff to roll in bed, dress and transfer to tilt wheelchair without further assistance; Mobilising a large Participant remains too high of a risk for one Support Worker to perform alone; The risks and consequences of a Participant falling are too great for one Care Worker to manage without assistance of another; behaviour while traveling in a vehicle remains too difficult for the driver to manage whilst driving.

      Can the family act as a second Carer?

    1. This is not an easy question to answer because it is not always a black and white situation and it’s mostly shades of grey. For example, what level of assistance is involved? Is it simply moving a wheelchair into position for a transfer; Assisting with rolling the Participant for a bed bath; Hoisting a Participant during a transfer; Assisting with bathing a Participant who is on a ventilator; What are the physical condition, skills and abilities of the Carer; How does the Carer interact with the Support Worker?

    2. Sometimes the parent or other Carer, has more skills and knowledge of performing a task with the Participant than the Support Worker, e.g. A very high needs Participant who is ventilator dependent, fragile with a large variety of serious health concerns, and their input and assistance is incredibly valuable and needed; An adolescent Participant with self-injurious behaviours, as part of frustration management that the Carer is very skilled at handling. Sometimes the highly experienced and skilled Carer educates and trains the Support Workers for specific tasks or behavioural management.

    3. Some organisations have firm guidelines of what is and is not appropriate for Carers to assist Support Workers with in order to protect the safety of everyone concerned. Guidelines may be made based on legal implications should the Carer get injured while assisting, should the Participant get injured while the Carer is assisting or should the Support Worker get injured while the Carer is assisting. Guidelines are sometimes also based on input from insurers and the impact of acceptance of claims or premiums by having the Support Worker assist in a service. Make yourself aware of the Guidelines in your organisation.

    4. The reality is that there is no one right answer. Usually the answer is…Well, it depends on the situation. An organisation must consider the Participant’s specific needs, the circumstances of the tasks involved, the risks of the Carer assisting or not assisting, the costs to the paying Participant or Carer, the Participant’s wishes, the obligation to keep Care Workers safe, risks to the organisation and etc.

Will the funding package cover the costs?

  1. Decisions for the need of a two Support Worker service should not be made lightly. There are many internal and external stakeholders that require solid reasoning for the justification of this level of care and its associated costs, which may or may not be fully funded by governments, insurances, the Participant or Carer. This is why a well documented and thoughtful assessment, findings, rationale and plan are necessary in order to have the confidence that the recommendations being made serve to improve the care or safety of the Participant and the safety of the Support Worker or others. Documentation should include whether it is anticipated the need for two Care Workers is temporary or permanent. Documentation should also include options that were considered, trialled or reasons for delaying the options.

  2. It is common for both internal and external financial decision makers to require a report from a clinical specialist such as an Occupational Therapist before making a funding decision for or against a two Support Worker service.

  3. On occasion a Participant or family member request a two Support Worker service that is not necessary from the perspectives of improving care or safety. In situations such as this, public funding bodies tend not to cover this added cost unless there are clinical or other justifications for this.

  4. Sometimes the Participant or family cover the added costs if funding bodies do not.

  5. Sometimes the organisation will temporarily or permanently cover some of the costs that are not met by the Participant, Carer or funding bodies.




Decision checklist

Before deciding on a two person service you need and answers to these questions.

If you complete the form for a particular person you may wish to print it as a record of your thinking.

Two person service: Decision checklist

Name: This is only for your use if you print this form.

1. Why is this necessary?


2. Will it achieve what we want?

3. Have ways of minimising the costs been considered?

4. Is this a temporary or permanent adjustment?

5. Can the family act as a second Carer?