Direct Support Staff
Winter 2022 - Winter 2024
From winter of 2022 through winter of 2024, I worked in a group home supporting individuals with disabilities in their home and in the community. This experience was vastly different from other jobs in which I had worked with vulnerable adults. In the past, I had worked mostly with older adults. While they all would often have different ailments, cultures, and abilities, there were usually similarities between them. In the group home, each person was very different from the others. While this was intimidating at first, I found this experience to be a wonderful introduction to providing true individualized care.
While my experience working with older adults prepared me for the medical care some of the adults in the group home needed, the courses I’ve taken regarding disability proved to be extremely useful in learning how to provide respectful and comprehensive support. I had learned the damage making assumptions about a person’s ability can do, and I was determined to treat each person as an individual.
When I started the job, I was given a binder on each individual. The binder contained information about the areas where each person needed support, and it contained insights about each person’s interests, likes, and dislikes. I studied those binders thinking they were the key to knowing everyone and providing that comprehensive individualized support. But once I started working, I realized this wasn’t the case. While the binders weren’t technically inaccurate, they couldn’t possibly describe the way each person’s personality and needs would fluctuate from day to day.
I learned that most of the individuals in my care would tell me what they needed and how I could support them. I would listen to them and remember their preferences beyond what the binders told me they liked. While this was a good method most of the time, I also had to remember that these individuals were in need of support for reasons beyond their physical disability, and they could not always make good decisions for themselves.
The traditional group home model encourages staff to ride the fine line between allowing the individuals supported to make mistakes while also keeping them safe. This lead to a lot of hard decisions in how we created boundaries and limitations for each person. Some individuals were free to do almost anything they wanted to, while others needed to ask permission when they wanted to do things or go places. And not all those who needed to ask permission and follow certain rules would.
This created a difficult and unavoidable power dynamic at times. I wanted to respect them as individuals, but my primary responsibility was to keep them safe. I found it difficult to tell them “No” in a way that still respected them. Sometimes it was helpful to explain why the answer was no, but often they would become offended or object to the explanation. I thought back to my previous classes, and remembered that respecting someone as a individual also means respecting their opinions and feelings. They didn’t need to like me or the way I was preventing them from doing what they wanted to do. I instead started giving them the space to be upset and resentful, as those were feelings they were entitled to having. Different strategies for communication worked for different individuals, and it was my responsibility to ensure I could communicate with them effectively.
This experience combined many different things I learned from my development experiences. I remembered the platinum rule, which is treating others the way they want to be treated. I also remembered the concept of spoiled identities, in assuming things about someone based on their identity. This opened my eyes to a new aspect of spoiled identities, too. I thought I knew everything about the people in my care based on their informational binders, but this ended up being an aspect of spoiled identities because the binders didn’t encompass everything about them. The binders ended up contributing to a harmful stigma, because they made us believe we could support that person only based off of information assumed about them. Reading the binders also wasn’t the same as getting to know the person, and that was a misconception I made.
Through this experience, I’ve learned that person centered care is the only way to go if you want to support someone in a way that respects their unique identity. Sometimes, the healthcare system pushes the model of treating everyone the same way, but that just doesn’t work. Everyone deserves to be listened to and respected for who they are. Going into this experience, I knew that, but I hadn’t seen the effects of it first-hand. Taking the time to get to know a person is essential to providing culturally competent care. My experiences providing person centered care will greatly help me in the future as I work towards a career providing care as an Occupational Therapist.