Direct Care Professional Network

When we think about it, DPS’s are the eyes, ears, hands and nose of clients’ medical teams (PCP, agency nurses). We use these senses when providing care and with the right skill, we can assist the team with valuable information that may avert a serious problem. Things get confusing though when we make judgments about the things we’re seeing, feeling, smelling and hearing.

There are two types of observations.
Subjective and objective.

Objective observations are fact. They are measurable.
• Vital Signs
• Bruises
• Open Areas and other skin conditions
• Blood in urine
• Urine output from a cath

Objective observations are reported in the same manner by many people. They are not biased and they do not rely on statements and guesswork.

Subjective observations are made by the patient:
• “I have a headache”
• “I feel sick to my stomach”
• “My sugar levels are off”

How we observe
Using our eyes we see things:
• Broken skin, open areas, cuts, bruises
• Blood- in urine, in and around the mouth
• Changes in the patient’s ability to walk, speak, eat

Using our hands we feel things:
• Pulse
• Skin temperature (warm, cool)
• Lumps and bumps under the skin

Using our ears we hear things:
• B/P readings
• Respiration problems (wheezing, coughing)
• Patient’s statements

Using our noses we smell things:
• Body odors
• Foreign odors not normal to what we are doing (gas and oil, chemicals and the like).

Subjective observations are reported by the individual and are just as important as objective observations, except they are not measurable.

The medical team need to know when clients have complaints such as those listed above. DSP’s cannot pass judgment on these statements.
It’s not in our role to do so. Our job is to REPORT the statements, accurately and without added
flair. I often see DSP’s report observations- with their own opinion added in. This isn’t necessary and it’s not good to do. Just the basics is all that is needed. If you’re asked for more information, like, “What do you think is going on?” then by all means give your opinion. But don’t offer it up front as part of the observation.

Examples of DSP statements that are not correct:
Incorrect:
“Mrs. Smith says she has a headache. She does this whenever it’s her bath time!”
Correct:
“When I went to assist Mrs. Smith with her bath she stated that she had a headache.”

Incorrect:
“Mr. Jones ambulated ten feet today; he said his foot hurt…yesterday he was fine and walked a hundred feet and his foot didn’t hurt! He’s being lazy.”
Correct:
“Mr. Jones ambulated ten feet today.”

Incorrect:
“Ms. Hawthorne had a really loose BM and it smells like C Diff.”
Correct:
“Ms. Hawthorne had a loose BM that was very foul smelling.”

I think we get the picture here. Many of the things we know from experience with our work turn out to be true. Ms. Hawthorne probably does have C Diff…we can tell by the odor. BUT it’s not up to us to report that as fact. Are we absolutely sure Mr. Jones is being lazy? What makes us assume that? IS it possible that his foot really does hurt? As DSP’s, our job is NOT to make assumptions and diagnose conditions. We observe, we report. It’s pretty simple. No need to embellish our reports with our own opinions. We’re not always right.

Observations must be accurate.
Observations must be made in a timely manner and when necessary the medical team must be notified of unusual findings.
Observations must be free of our opinions and bias.
Report patient statements word for word…directly quoted. Don’t add your own thoughts.

You’re thinking about becoming a DSP. You’re excited and want more information about this career. Some questions you might have deserve answers, and here we will try to do that.

What is a DSP?
Direct Support Professional, also known as personal care assistants, caregivers, home health or personal care aides, residential counselors and CNAs give assistance to people who are sick, injured, mentally or physically disabled, or the elderly and fragile. DSPs provides a variety of supports to people with disabilities in their homes or on the job. Most of these individuals need assistance with a variety of day-to-day events such as: household chores, getting ready for work, going out and having fun with friends and family, meeting new people and being active members in community organizations and places of worship, running errands like going to the bank, the doctor, or the grocery store, or performing work tasks.

As a direct support professional, you will spend most of your shift in direct contact with the people who need assistance.

• DSPs support many people who have physical disabilities and who need assistance such as transferring from a bed to a wheelchair, from a wheelchair onto a toilet, or from a wheelchair into a bathtub. Although in many situations you will have equipment to assist you, to support these individuals it will be important that you are able to lift 50 pounds or more. Some individuals may also need assistance with all of their self-care needs, including help in changing adult disposable briefs.
• Some of the people who receive supports from DSPs have challenging behaviors. This might mean that, depending on the situation, a person who you are supporting could yell at you, call you names, pinch you, spit on you, throw something at you or hit you. This may sound scary at first, but with training, many new direct support staff with no prior experience have learned how to respond to people in a way that helps them calm down and move on. It is critical to pay attention to the training. Many people who have challenging behaviors also work with psychologists or behavior specialists. These professionals work with direct support staff to develop and implement plans designed specifically to help people with challenging behaviors learn new positive ways of expressing themselves.

The Direct Support Professional maintains positive and professional relationships with the individuals served, their families/guardians, their peers, community partners and government agencies and assists in the implementation of Individual Support Plans for individuals based on assessments, objectives, and goals.

Direct support professionals may be expected to take a course in medication administration, first aid, and CPR. Once trained, you will give medications to people to whom they are prescribed. Direct support staff may also provide certain prescribed medical treatments, such as tube feeding, glucose testing, or administering suppositories. You will be expected to document all of the medications you administer and all of the treatments you provide each and every time you complete these tasks. You will also be responsible for monitoring the general health and safety of all the people who you support. The training for all of this is comprehensive.

Will I Make A Good Direct Support Professional?

How do you know you will be good at direct support work? Here are some of the traits of a good direct support professional:

• Caring and compassionate
• Honest and loyal
• Accepting of others as they are
• Flexible and dependable
• Punctual
• Shows initiative and creativity
• Hard working and a team player
• Interested in learning
• Good at communicating with others
• Respectful of other people

Am I qualified to be a DSP?

Qualifications, based upon average state requirements as well as typical agency requirements:

• High school graduate or equivalent.  Additional experience with people with developmental disabilities preferred or as required by regulations.  Must be 18 years of age, or older.
• As applicable, must possess a valid driver’s license and good driving record.
• Additional certifications may be required by regulations. – Some positions may require access to vehicle in sound operating condition and proof of current auto insurance.
• Clear background checks as defined by regulations and policies. –
• Ability to lift at least 50 pounds. Ability to do daily standing, bending, and lifting. Must be able to stand for 8 hours at a time.
• Interest in assisting people supported to achieve personal outcomes and to provide person centered supports. Must possess good verbal, reading, and written communication in English; basic math skills; and basic computer skills. Ability and willingness to successfully complete and apply training.
• Must be certified to be free of communicable diseases by a physician (Tuberculosis/TB); have the ability to work effectively and harmoniously with others.

 2) Why be a DSP?
If you’re looking at a career in human services, being a DSP is a great way to really test yourself on this goal. Being a DSP exposes you to many members of the health care team: Doctors, nurses, therapists, social workers, service coordinators, program managers and others in action. You’ll soon know whether you have what it takes to further yourself in **residential** as it is often called; you may decide you want to start as a DSP and work your way up.
If you’re looking for a quick job to pay bills for a few months becoming a DSP might not be the right choice for you. Training requirements differ from state to state and agency to agency, but one thing is common: Assisting people with disabilities is hard work! It is physically demanding and you will need patience and compassion. You will want to pay close attention to your training to learn about all the skills required to do this work. Unlike CAN training where one learns the bulk of skills prior to job placement, DSPs often are expected to learn skills on the job.

Career DSP: You won’t get rich doing this for a living. DSPs don’t earn a high salary. You should be very aware of this. Many of who have been doing this for a long time notice new DSPs coming into the field, who get disillusioned over the pay. We’re paid by the hour; that rate is dependent upon several factors which include how much experience one has; what region of the country one works in and where employment is at.

In general, DSPs who work in a group home supporting disabled people earn an average of $10 to 14/hr to start, depending upon experience, level of education and any certifications and trainings already completed. DSPs can earn up to $18/hr as a national high.

3) Where can DSPs work?

• Agencies that provide residential and day services to disabled people (Easter Seals for example)
• Local Staffing Agencies
• School Districts

4) How does one become a DSP?
It’s not hard: Apply for a position at any one of the above mentioned agencies. Almost all will hire you and train you. In many states there are mandated training requirements which can only be accessed once you are employed.

5) What Can I Expect during My first 90 days of employment at an Agency?

• An orientation that lasts anywhere from 4 days to 2 weeks
• CPR class
• Resident Rights
• Infection Control
• Skills required to effectively manage and redirect physical behaviors
• Agency policy and procedures
• Abuse/Neglect Training/Reporting Requirements

 

There are many opportunities for DSPs to learn, grow and even become certified by national groups- one of the benefits to inquire about for employment would be whether agency provides access to such certification.

Good luck! If you choose to be a DSP, you will be rewarded in many ways.

It isn’t rocket science- keeping a job. But it seems, more and more, that some people really are clueless when it comes to certain actions that will, guaranteed, send a DSP out the door via being fired. These DSPs act all shocked and awed. REALLY??

YES.

1) Be a NO CALL, NO SHOW. Don’t go to work on any given day you’re scheduled. Perhaps you have a doctor appointment, or you need to catch up on some much needed sleep. Or your kid is sick. Whatever: This action on your part will end your employment at every facility and agency.

2) CALL OUT MORE THAN ONCE EVERY OTHER WEEK: Believe it or not, residents/clients depend upon YOU to show up for work, to assist them with the care and services they cannot provide for themselves. When you call out, someone ELSE has to pick up your assignment. Or as more often happens, your coworkers will see their workload increase. They will complain about you. Even those who say they are your friend. The complaints will be bitter if you call out a lot (more than 3 times a year).

3) Be SNEAKY WITH your DOCUMENTATION. I have known some pretty sneaky DSPs who do things that are absolutely appalling. Taking shortcuts that are genuinely dangerous to good health, lying about cares given, documenting incorrect or made up data, falsifying records, writing in numbers for VS, making up percentages for meal intakes- it all falls under one category. If you’re doing this, your peers will catch you. The good ones will report you.

4) Abuse and or NEGLECT YOUR RESIDENTS: WHOA everyone knows this, right? No. As many media reports show us, aides get together and partake in terrible acts towards the residents. They use their cell phones to take pictures of clients and residents in extremely undignified manner. They post things on Facebook and Twitter; they take SNAPSHOTs thinking no one will ever find out. They don’t realize peers are watching.
People are outside doors listening. Sooner than later a peer will report these behaviors. Bruises tell stories. Residents sitting in wheelchairs, not being fed are stark reminders of neglect. Large open areas are also evidence of neglect. When the residents you work with start having patterns of problems, it will be noticed. You stand to lose more than your job.

5) TALK LIKE A DRUNK TRUCK DRIVER: Swearing, tough talk, threats- we see this all the time in movies. Is it necessary? No. It is ever called for in the nursing home/group home environment? No. It may make you feel better, or make you feel important or different. But it’s a sure fire way to get fired- and quickly. Foul language also diminishes the professional image we want others to have of us. When we cuss and swear, we deserve to not work in this field.

The harsh truth about social Media, the Internet and Human Service Work:

Many of today’s CNA’s & DSPs seem to think it is perfectly ok not to show up for work without a call; many don’t understand the concept of tardiness and how it effects work flow.

Cell phones and Facebook take up much time and attention, while client engagement is a foreign concept. I worked with a girl with literally broke down and cried when I told her to put her cell away for the day.  Another new staff got jittery when I told him we have no Internet access- he wanted to check his FACEBOOK. What does all this have to do with getting fired? Think about it. When you’re more concerned about who is texting you than you are with providing a bed bath you’re asking for trouble. When you would rather check your friends status updates then assist your resident with eating, you’re asking for trouble. Work is work. It’s especially hard work in a community residence or nursing home or hospital where other people depend upon your attention to their needs.