Social Work Spotlight - Episode 74: Cathy O

Episode Date: January 6, 2023

In this episode I speak with Cathy who in over 25yrs as a social worker has worked in the community sector and multicultural aged care, in an acute teaching hospital in rehab and aged care, and has developed training tools and social work group supervision. Cathy has now returned to community social work in Northern Sydney for the Community Nursing program, visiting patients with chronic and complex issues.Links to resources mentioned in this week’s episode:Severe Domestic Squalor by John Snowdon, Graeme Halliday, and Sube Banerjee - https://www.tandfonline.com/doi/abs/10.1080/13218719.2013.761743How to Use Social Work Theory in Practice, An Essential Guide by Malcolm Payne - https://policy.bristoluniversitypress.co.uk/how-to-use-social-work-theory-in-practiceBuried in Treasures - free 15-week online group program, providing in-depth training and support for people with hoarding tendencies - https://www.catholichealthcare.com.au/events/buried-in-treasures-support-groups/#:~:text=Buried%20in%20Treasures%20is%20a,12%20who%20share%20similar%20experiencesThis episode's transcript can be viewed here:https://docs.google.com/document/d/1wMzkGX8GTQkKYxdXx6I_dt2WJUAu9TLIkKCGEXaL-tU/edit?usp=sharingThanks to Kevin Macleod of incompetech.com for our theme music.

I begin today by acknowledging the Gadigal people of the Eura Nation, traditional custodians of the land on which I record this podcast, and pay my respects to their elders past and present. I extend that respect to Aboriginal and Torres Strait Islander people listening today. Aboriginal and Torres Strait Islander peoples have an intrinsic connection to this land and have cared for country for over 60,000 years, with their way of life having been devastated by colonisation. Hi and welcome to Social Work Spotlight where I showcase different areas of the profession each episode.

I'm your host, Yasmeen McKee Wright, and today's guest is Kathy. In over 25 years as a social worker, Kathy has worked in the community sector and multicultural aged care, in an acute teaching hospital in rehab and age care, and has developed training tools and social work group supervision. Kathy has now returned to Community Social Work in Northern Sydney for the Community Nursing program, visiting patients with chronic and complex issues. Thank you so much for coming on to the podcast. Lovely to speak with you about your experience and just thank you for your time in doing this. Well, thank you, Yasmin, for asking me and I feel really privileged.

I'd love to know firstly when you started as a social worker and what brought you to the profession. Well, I guess what brought me to the profession, I did come. from a, I guess, a multicultural family. And my family and personal experiences, I suppose, brought me where I am today and into the profession as a social worker. And I guess what really catapulted me to a degree was my mother was very, very unwell.

And I became a carer at a young age. So that brought me into becoming more interested about what's involved in helping people and I always thought I had something that I would work towards in that area but I just wasn't ever sure and just from a personal experience having gone through my own growth as a teenager a late teenager and having migrated to another country and met family that I never knew existed in Australia I actually decided to look into something that continued. that growth and that self-awareness of who I was and where I was heading and what contributions

I could make in my life and to other people around me. And after my mother did pass away, she died from cancer. I had thought, well, maybe I could look into something that actually helps people realize what their potential is in terms of helping others around them. And I guess that's where social work started to come into play. And I wondered what else could I do. So I looked around at all those different professions and wondered what was really available and was probably more catered towards me. A lot of people found that I was easy to talk to. So I figured maybe I needed to do something in that area. And lo and behold, I guess I just put my name down, hoping that something would come and sure enough fate had its call and I did I ended up getting through

to social work as a tertiary student and continued that growth throughout those years at university and it was really such an eye-opening course in itself that I really developed as a young adult I didn't have any parents around me in terms of having that parental influence anymore. I didn't have a female mother figure or a father figure around, and it was just my sibling and myself, really. And that sort of gave me that initiation into adulthood and at the same time that flexibility to delve into areas that I'd never thought of before. And that's where I started to reflect more about who I was and where I was going. So I guess social work fitted that category really well because

it was fantastic in many ways. And I'm still here learning from patients, clients, people, staff, everyone. So that's a long way to answer your question though. Yes, but sorry. That's how we do. That's the social work way. It sounds as though that would have been a very tricky time though navigating systems and advocating on your behalf and on behalf of your family while still trying to find your personal and your professional identity. Was there a point at which you felt like this was really the path for you, like you'd chosen the right way? Yeah, I guess probably when I started my placements is really when I started to think, this is it, this is really what I need to be doing. I had some great placements and I'd probably show my age by saying that I had three placements.

These days, not many unis have three placements anymore. So I had the luxury of having three different placements and two were community and one was in an aged care section of a hospital and I really felt that I could contribute in those areas but at the same time it gave me the opportunity to explore where I sat within those areas so that idea of working in age care and mortality my own mortality my family's mortality, my identity. I was working in an area that had a lot of people from different ethnic backgrounds, so a lot of European, Asian backgrounds coming in. So I also worked with the Red Cross in doing a lot of tracing families that were lost as well

and really enjoyed that. and it just brought up lots of different areas for me. And even to this day, I'm still keen to eventually get over to one of the Eastern European countries, which I haven't ventured to. But it continues to bring that desire to grow still, even though I'm not that young 20-something social worker that was years ago. I'm still keen to keep learning, but those placements probably consolidated where I wanted to go.

And in particular, the community development placements did. So things such as the Red Cross, working with ethnic communities. I did some volunteer work as well with some of the youth centres. And whilst I loved it, I just didn't feel the same connection to the other areas. It might have been because I felt too close to that age. I don't know what it was, but I just didn't have that same inkling, whereas working in different areas such as community development and aged people, geriatric, that was the area that seemed to really work for me at the time

and certainly has progressed further for me in those areas. It's interesting that you've kind of kind of. come full circle having both a community and a health aspect to the work that you're doing now. But as a newly graduated social worker, what were your priorities having that experience that you had? What did you want to first do when you finished uni? Gosh, when I first finished, I suppose I thought, as we generally do when you're coming out of a university degree, you think, oh, I'm going to change the world. most of us have that wonderful admiration to change what's out there and desire.

And to a degree I did, but at the same token, I was quite realistic, knowing that life throws different things your way and that you can't always change everything and there's a level of acceptance that has to be taken into consideration and you need to work with what you can. So I think I started developing that from a very early age that I really had to work with what I had as opposed to changing everything. And that obviously included my experiences from familial background to accepting where I was in life, which was pretty much a young adult with very little parental input, which I imagine lots of young adults would love today.

but that certainly I had to grow up really fast. So that was where I was and I was grateful that I had the opportunity to do so. But at the same token, I wasn't misguided that, well, here I am now as a social work and I can change everything in everybody. I understood that it just wasn't possible to do that all the time. Sometimes, depending on the people you came across, you could. But it was just a question of who was willing and who wasn't and how far. you could go.

Yeah. Have you had much of an opportunity to use your language in the work you're doing? I have. I have. Yeah. Are there benefits, challenges to that? Oh, absolutely. So I worked for CoASA, an Italian organisation, and I loved it.

I worked with a great bunch of staff over there from your psychologists to your educational teachers and to some wonderful carers and developed strong relationships as well with some of the community, being an Italian-speaking person, as well as understanding how the Italian culture, and not all cultures, but generally, once you're a part of the culture, there's that acceptance that, well, you know what we've been through, therefore you can understand what we're needing. there is that, but at the same time, there's also a little bit of, well, since you've come from our background, you've got to somehow break that avenue and give us a little bit more than what we're supposed to have,

which is really difficult when you're creating boundaries and trying to remain professional. and this probably was my second job out as a social worker, but that whole idea of where do I stand as a social worker, where do my boundary stand, where does my cultural identity stand, and how can I be accepted within this community without appearing as another bureaucrat who says this is where I am and this is where you are?

So it's interesting having to juggle all of that and still feel a part of that community, which was really, really important for the community development aspect of my work. So we were out there trying to create a larger community that was fulfilling and self-reliant rather than us having, as the organisation, having to always contribute and prop up the community. So it took quite. quite a bit of time, but because they were established as an organisation, I think that that was probably due to their credibility as an organisation. And sometimes that speaks words and the history behind it is probably what kept it in that stand, I think, for me anyway. And how did that

then lead to the work that you're doing now? What are the steps there? Yeah, gosh, lots of steps between there and here, I actually ended up working and developing a training program as well for multicultural staff in aged care. Interesting because another aspect of social work that I had never thought I'd ever get into training. And sure enough, I loved it. And this was training staff who were from ethnic backgrounds, staff that had no idea how to deal with people who were being cared for. So we're talking about someone who maybe was a palliative patient in a facility and they needed 24-hour care and how did they look after them?

How do they deal with families when they come in? How do you deal with the fact that maybe no one's coming to visit them? When they've come from a massive extended family, how do you manage the fact that no one is visiting and the loneliness that maybe those patients or relatives may be experiencing at that time. And it was really difficult, but I think it was quite a, it was an eye opener doing some training. I just thought it was fantastic because we were one of the first accredited courses to come through age care facilities and from there onwards it just snowballed and snowboard and it was I moved out of that training area and I got myself into age care and from

age care I was there in rehabilitation I was there for I took on a few different positions in age care as well in rehab I was there in community development in age care and the interesting thing in age care, it doesn't matter where you go in Sydney anyway and probably for a lot of larger metropolitan areas that the age population still has the same priorities in life. They just want to be heard and they just want to be given the opportunity to live their life. So with the Italian community, I worked in the eastern areas as well as the northern and the inner west. And of Sydney with the job that I worked in the hospital was mostly in the inner city with the current job that I have. I'm looking at the north and it doesn't really matter where you go and even with the job

that I was doing with training I was down in South Wollongong, Newcastle. It was a large area but the same I guess ideas keep coming back and the same priorities are there that people just want to be heard and people just want to be treated as a person. That is just probably really the essence of what social work for me is really about giving those people that chance and that opportunity to speak up for themselves. And so you're working in the northern Sydney areas at the moment and it's community home nursing. So I imagine you work with quite a large, diverse, both culturally, language, professional, multidisciplinary team.

There are other community social workers that do exist. So we do actually have a professional development team that we try to meet every couple of months where we can discuss our own profession and how we can progress and ideas that we have professionally. And I supervise two other social workers who are within the Northern Sydney area. And I do that on a monthly basis with them. And in terms of multicultural, yes, it is very multicultural. There's, you name it, we've got people coming from Eastern European, Asian backgrounds, from

everywhere. I don't know if we've come across any Aboriginal nurses yet. I don't know if I have come across Aboriginal welfare workers, but not Aboriginal nurses as yet. I've had some tremendous nurses come through. And there's all different degrees of nursing. well. So that whole idea of that medical model and being behind that medical model, I know that some people feel very skeptical about working within a medical model, but in the community,

it's really different to a hospital. A hospital setting is extremely hierarchical in terms of a medical model, whereas in the community, there is just so much flexibility and so much space for movement and nothing is really rigid. Nothing is rigid and you might be going on a visit one day with a nurse and the next time you might be turning up and there could be a whole group of carers who've come to see that patient that you were meant to see which then means you've just got to be extremely flexible and they could be coming from different walks of life so you really don't know what you're dealing with sometimes when you walk into a patient's situation. But yeah, it's quite diverse and certainly has some great aspects of it.

I mean, it's just, it really goes to show that we are in an international service in lots of ways, even though we are in the little area, local health area of Sydney. I'm really privileged that we do. such diversity in our team. Yeah. Do you have an opportunity to supervise students then within your role? I have in the past. I have supervised students in the past. I have also done some work for the Australian Catholic University, supervised students through the Australian Catholic University and students as well when I was working as an aged care social worker. And yeah, it's interesting. how people come with different perceptions about what social work is as a student

versus someone who has been in the profession for a number of years. Yeah, it just blows me sometimes to understand the differences and the extreme variation from one to another. And I don't know what it is. I don't know if it's the way the course is presented or whether it's just the individuals themselves, but I think it's great. Yeah, I do think it's great.

I feel like it would be such an individual thing because you could have someone coming in who, I want to say very vanilla, like not exposed to much in the way of the sorts of issues that you'd come across and then you'd have someone like yourself who at a young age has had to deal with such hardship and caring responsibilities and exposure to systems. So, yeah, I feel like each person will get something out of exactly the same sort of placement opportunity. Yeah, I agree, definitely. It sounds as though you mentioned there is a lot more flexibility in the community setting and in hospital, in my experience, at least there's a huge pressure on discharging people and moving through the system. But would you say that a positive thing about your work is that there is more flexibility around when you discharge someone from your caseload or even just goal setting and having that opportunity to spend more time getting to know.

someone? There is definitely and I think the other part to that too Yasmin is that you're going into the person's home so I visit a patient in their home as opposed to a patient coming into a hospital and being cared for by a whole team of staff so I'm very mindful that I'm entering their domain where they're in control and certainly they, as I said, it's their domain, it's their control and I can't dictate how things are to pan out except that working with them, trying to work towards specific goals or what they want to achieve. So I technically have a timeframe, but at the same time, I can work within that time frame based on what I see is achievable.

So it can't go on indefinitely that I see patients. Otherwise, no one knew will come and I won't get to see other patients. But at the same time, I still need to be able to have a plan and still need to have some sort of an idea of, well, we've achieved this now. Let's work on something else. And if we can't achieve the next goal, well, maybe we've achieved as much. as we need and the nurses will continue to see you and I'll be asked or referred again to come and see you if necessary. So I'm really fortunate in that sense that if the nurses are seeing the patients

then they can re-refer to social work but I don't have an end and the beginning as such whereas in the hospital you do because they're in the hospital and they've got to be out and that's what they're about. Yeah. And have there been times when you felt unsafe going into someone's environment, whether it's a physical safety thing or even just the way that an interaction has made you feel personally? Yeah, it has come about in both instances, I would say, probably both in the hospital setting to a degree and in a person's home. But I never felt unsafe to the point that something was going to happen to me. It may have been initially, oh, this is rather confronting what's happening here. I'm just not sure. Let me take a step back in

my mind to evaluate quickly what's going on before I make the next step. So that's all happening in your head very, very quickly. It doesn't take two minutes. It really happens in a matter of seconds or that processing. I can recall in a hospital setting where we had a family meeting and it was quite a heated family meeting and we had a family member come who was extremely angry and had a lot of his own issues that still needed to be worked on and as a result of that he was venting all of his anger and frustrations in that particular meeting and to the point that not only was their verbal abuse, but then started to get physical. And so luckily, he walked out and we were able to take on board some security measures that we needed in that case. But going into

people's homes, again, it is their domain. So what I'm going to go. in with is my own safety and knowing what I have in place to be safe in someone else's environment. So being very conscious when I'm walking into someone's home for the first time that I actually go with a community nurse. When I'm in that home, if I feel unsafe or if there's verbal abuse or if there's any physical abuse where things are being thrown, then there's nothing to compromise our safety as professionals, we just have to leave. And so at this point, I haven't had to get to that level where I've just had to leave. Most often I've been able to de-escalate situations, either with colleagues or on my own and with the patient. And it's just

really important in those situations to remain calm and to work with what you've got. And that's essentially our skills as a social worker to try to work with what's in front of us at the time. Yeah, in terms of physical safety, gosh, there's some of the places I have gone into aren't necessarily, I would say, safe in the home environment. So there would be some places that many people would deem to be unsafe and unhabitable, but I still have ventured into those. And it's interesting how quickly other professions can be quite judgmental and still decide, well, there's not much more that we can actually do here, is there?

So they're almost looking for confirmation to say that, no, there isn't anything else that we can do. is there? No, no, you're right. Well, we've done everything. It's quite dismissive. It is. It is. And I guess I want to work in those areas because those areas are the difficult ones and they're not your straightforward. This is where we go. There's an answer here because most often there isn't an answer and everybody's looking for a very quick, fix answer and there just isn't. So the process is what needs to be worked through with the person. And if it's possible to engage with them, then great.

And sometimes we've been able to engage with some of those people. And I can remember having dealt with a few difficult situations and two women come to mind that lived on their own. The house was extremely unsafe for them. Yet this was their home. This has been their home for so many years, and there'd be no way that anybody could turn around and say, you can't live here anymore. Thank goodness we don't have those regulations to say you can't live here unless there is

personal safety issues and cognitive problems where people do need to have others decision makers come in and make those decisions. But in these two situations that I'm thinking of, it was just, We worked with them and we made some inroads, some safe inroads with them, and they were able to return to their homes and to continue, if it is for another five years, so be it. If it's more, great. But what they wanted was to go back home. One woman in particular, all she wanted to was to return to her two cats,

two cats that had disabilities as well, while she was unworked. We had to have the cats looked after. The house had to be cleaned out, essentially, but none of that could be done without her permission and without her presence. So we had to engage with her to come, to be there. It was very, very time-consuming and extremely worthwhile process for her, though, in the end, because she realized what she still had available to her and that she still had a life to live,

regardless of her being unwell, she still had something in her to give. The other lady that I was thinking of, she had suffered a lot of trauma in her life and had found it extremely difficult to manage. And the way she managed was simply, by purchasing and looking after herself by buying more and more and more and more and more became too much to a point that her unit was just extremely overcrowded with everything from

things that she bought for children she never had to parents that had gone 40 plus years years in her life. So there was a lot of loss in her life. And it took some time, but it also ended up in her case rekindling a relationship with past relative that she had and working at how they could reconnect, which was incredible because she was so thankful in the end that she had been able to talk about some of these things to someone else rather than simply keeping it or to herself. Yeah, so it's, I've never felt unsafe, but certainly have had challenges when it comes to feeling emotionally safe, I suppose. Yeah, there's different levels of safety. It's not just that physical aspect of safety that we need to take into consideration, but also that idea of emotionally

feeling safe and I think sometimes we've got or certainly I have seen a lot of patients who have been emotionally unsafe which then has led them to come into contact with a health service somewhere along the line and that can be quite dismissive of some services but not all and I'm just really thankful that I've had the opportunity to get involved in some of those lives yeah I think social work is well positioned to examine how a person got to the position that they're in and how that itself affects the way someone interacts with a system. So I guess giving the time to understand the person and providing them that dignity of choice in the way that a service is going to respond to their needs is so important, which in so many other settings might be overlooked and might influence

the way that someone perceives a system like the whole system. So I think what you're doing is very intentional in trying to make sure that those voices are heard. Yeah, yeah, I think so. Are the people that you support mostly in the age care system, or do you have people who are younger with disabilities that you're supporting? Yeah, so generally I work with people with chronic and complex health conditions at the moment, as well as aged. So it's a combination. I do work with people who are under 65 for a cutoff point and people who are over 65. I don't work with young adults in the sense of 20-year-olds,

but I certainly have come across a couple in my contact with the families that I've dealt with. but a lot of these individuals, a lot of these people have actually disengaged in one way or another, I guess from society and from services and contact. So the age group is roughly in that probably 50 plus all the way. I think I've got one patient at the moment is about 94 years of age, which is fantastic. Yeah. And I would imagine the home nursing program would be doing a lot of assessments, looking at pain management, medications, ability to manage functional tasks.

You would be involved in a lot of counselling. What does your day-to-day look like? Yeah, so look, my day-to-day, I guess starting from a beginning of the week, like the first day of the week, sit down with two nurse consultants, and we go through referrals and discuss referrals that we might need. some ideas to work through or suggestions, a bit of a discussion in our case reviews and then delegating and working with our patients that we've had referred from the different Sydney Home Nursing centres and then simply organising my working week for visits to going out to visit

the patients in their home. And that entails, unfortunately, one of those boring things of booking a car and doing the mundane things that you have to do. And negotiating, meeting with a nurse, meeting with the patient, those admin side things. But I don't have the same day in or out. I think most of the days for me are all different. And then with COVID to when our first lot of lockdown hit,

our service was pretty much the only service that was actually still going out and seeing patients in their home. So we continued to visit no matter what. And I was visiting patients as well. If I wasn't visiting, I was doing phone calls. And now with telehealth, we're able to do that as well. Preference is obviously face-to-face, in my opinion. And I think that that's worked now a lot more. But yeah, I couldn't say that I have any two days that are the same, to be quite honest. Most of them are very different. And then on top of that, I guess we've got education as well. So I'm actually educating the nurses about what social work is and how social workers can be useful in their whole, I guess, connection with the patients that they have and areas that they can

think outside of, well, I'm here to do pain management or I'm here simply to look at medication. There's so much more that nursing can look into when they're in a person's home and visiting them and how they can go about referring in the community if it's necessary as well and giving them that opportunity and delving into areas. It can be anything from dealing with abuse to dealing with. with hoarding to dealing with, you name it. I end up getting calls as well all the time. So it's not just visiting, it's also actually dealing with the staff.

Yeah. I would imagine in the course of doing this work, either formally or informally, you've had to develop like a priority criteria for your screening because I can just picture myself in a meeting with the nurses at the beginning of the week and they're telling you the story. of the people that they're supporting and you just be like, I can help that person with this, that person with this, everyone needs social work, everyone gets a social worker, it's like an

episode of Oprah. But I know when I worked in the rehab unit at a busy hospital, there was a blanket approach to social work. We saw everybody because it was expected that everyone coming into rehab to some extent would benefit from a social work assessment at the very least. How do you prioritize how do you work out your week knowing that you've only got a finite amount of time and you can't just delegate someone else to look after some of those cases yeah i do have a criteria yes absolutely i need to have a criteria and part of that criteria is looking at the person's age do they live alone are their supports and is there a carer involved and the degree of stress and volatility. They can be very subjective. Obviously, age isn't, but I guess the other

criteria are generally quite subjective. So what I do is I will always call the nurse that's made the referral before I go and see them. So I can gauge, apart from reading notes that may have already been written and assessments that may have been written, I will call the nurse and follow through with what exactly is it that they're asking. So if it is a gentleman who's at home on their own, hasn't been able to get out of the house, hasn't engaged with any assistance, however he's not eating well,

there's no family around. Is there anything a social worker can do? Generally, that might be something I might get as a referral. Well, I'll call that nurse to say, will have you tried to contact a next of kin, have you tried to follow up with the GP if there's anyone else that he's got a friend who's nearby who he has contact with. So trying to explain to the nurses that there's more than just what's there in front of them. There's more to the person. And maybe that does come from that idea of working in the system and understanding the systems

around each individual as opposed to simply just looking in one direction. Yeah, so, yeah, there's definitely a criteria. And you're right. Otherwise, I'd be seeing absolutely everybody and you just can't. One of me and too many people out there is just not doable. Yeah. And what happens when you're on leave? How do you coordinate that?

Yeah, then in those situations, the specialist nurses that are involved with, the cases tend to look after them and that's worked so far, I have to say. And it can be difficult when people do become dependent, absolutely. And I have had to have those conversations with patients where I've had to say, look, there is very little that we can continue to achieve. and if you wish to have further input, the GP can actually follow through if necessary. Yeah. I can imagine, especially since you're so closely involved with the clients, the patients and their families,

there'd be a lot of work supporting people to make significant life decisions, which brings a whole bunch of conflict resolution and other skills to the party. Do you find that challenging or is that one of those? things that kind of gives you energy is working through those really complex scenarios. Yeah, it can give you a lot of energy and at the same time, I think it gives you energy at the time that you're working through it. And when you reflect and go through your cases, then you start to realize, gosh, that was quite a lot to have to unpack. But at the time, it's almost as if your adrenaline, if you want to call it social work, adrenaline is pumping through.

You're on autopilot. Yeah. It just is going through those motions and you need to do it. Whereas there are times when you sit back, realize and supervision and upon your own reflection, your critical reflection that you have gone through a lot and you've really, you've delved into areas, that could trigger so many different areas professionally. And how do you deal with that? Yeah, it can be exhausting sometimes.

But I don't delve too much in that, to be quite honest. Yeah. I can see how there'd be such an important education piece for your domain, working with other allied health professionals around when someone's decision making is in question. And you mentioned the example of hoarding and squalor. And I'm guessing there's a lot of your role that looks at guardianship and capacity and someone's ability to make decisions. You mentioned cognitive issues a bit earlier.

What is your role in all of that and how do you support someone in those circumstances? Yeah. So look, there's definitely been a number of nurses that I've worked very closely with. and our external professionals and services too that I've worked with where we have gone through and had to have capacity assessments for patients and we've had to go down the path of guardianship and we've had those discussions with family members as well. It's not always taken too kindly.

You can imagine if a child is told that their father doesn't have capacity to make decisions and yet that child is the one who has been making all the decisions for their father and that an external body maybe needs to come into play and it's really tricky when it starts to look around those areas of financial abuse and looking at areas of safety in the home as well and where there's been neglect of individuals and that becomes a tricky situation and the difficulty is that a lot of services having worked both in the hospital system and in the community you can see how hospitals relate to those difficult and tricky areas around capacity and managing at home by simply discharging the person home, waiting to see how that

succeeds or doesn't succeed. And unfortunately, in the community, you cannot discharge them anywhere. You are dealing with the complex situation at home. And that means sitting down and making it very clear that this person can no longer remain and there are times where I've had to have those conversations with the hospital staff, as well as with the services that are coming in. My colleagues are great in those areas too, so we've got geriatricians who will actually go in and do assessments.

We have fantastic nurses who specialize in dementia and cognition, and they really can gauge whether a person has that capacity to make a decision, but ultimately the decision doesn't remain to them. It's a team decision that come together and say, this person is no longer safe to remain at home for reasons of cognition or reasons of physical safety. They're making poor decisions around their health, therefore we have to follow through with things such as a guardianship application.

There's colleagues that constantly ask me, how do we go through the process? So I help with educating them through that process, but also providing support in terms of written support for applications as well, as many social workers do these days. and it's not something that I jump to straight away. I prefer to see if we can work out other options first because the whole idea of taking someone's choice away from them just goes against the grain of social work for me and it's not something I'm comfortable with.

But seeing enough evidence from other allied health and from nursing and from doctors, then certainly the writing is there that it has. to be taken into consideration that this person is no longer able to make decisions for themselves and it has to be another person who makes those decisions and it's a tough call. It's not an easy call to make. It's a huge amount of responsibility because social workers, a lot of the time are, I guess, for want of a better term, the gatekeepers for that process. So you're the ones to confirm with the treating team and the family that, yes, there are no alternatives because

you know that once you get in front of a tribunal, they'll want to know what you've explored to this date, what alternatives have been looked at to help them to come to a decision that there are no reasonable alternatives, which can be, it is a burden, but I think it can be quite empowering, especially when the evidence is not there and you can then provide that education and support around how do we support your decision making rather than find a substitute? Yeah. It's a really important role for social work. Absolutely. Yeah, it is. What support do you then need around all of that? You've mentioned supervision,

you've mentioned keeping really good boundaries and professionality, but how do you continue to have the energy to do what you're doing? Yeah, so I guess I do meet with friends who are not social workers. I do a lot of reading as well, reading fiction. I like to escape in my world and I like to go for walks, long walks as much as I can and doing some of that mindfulness as well and getting my yoga back in to swing again. So they're important to me. So having that, I know it sounds cliche, but having a balance of my own time. And it's really important to reflect though and see where things have come into your life

and maybe have affected your life. But at the same time, realizing that's work and this is my personal time and this is my life. So going back right to the beginning how I said my personal life probably brought me to where I am today as a social work and drove me into that profession. I think knowing then that I had to make a decision about what was personal and what was professional really is important. And I've tried to maintain that, but there are times sometimes that I have to say that you might get a bit clouded. But I've got some great supports around me

and some wonderful people around me and a wonderful pet. So I have to say animals are great as well. They're very good at listening. Oh, indeed, indeed. There have been so many changes in your world, your professional world. I'm thinking like the whole my age care system was rehold almost 10 years ago. NDIS has come about in that time. The way that you help people to navigate those systems has

had to adjust. What do you see as the benefit of having those changes and how does that directly affect the people you support? Some of those benefits definitely would be for carers, I would say. And whether they're younger or older carers definitely has been beneficial for some of them. Not all. Not all. And I think seeing how there is meant to be, and I say this probably very cynically, how there is meant to be less bureaucracy and more direct service. However, I believe that there still is a huge amount of bureaucracy in trying to get services to people in their home,

whether it's through NDIS or whether it's through my age care, it still is a huge amount of bureaucracy. I think ideally if an individual or a family member could directly deal with a service, it is just so much easier to navigate that way. But we have moved from that model into a national model and it does have some drawbacks, absolutely, and trying to help people that is both the patient or client, but also the carers in that process,

can be extremely difficult at times as well when you're given the same answer time and time again, but it can help carers. I'm being very, very careful on what I'm saying because it can be very helpful, but it can also work. the opposite way for both. Well, given that it sounds as though you've got a lot of ideas or suggestions

as to how things could be improving, what would you like to see in this area over the next, even five, ten years, how could things be improved? And what would that mean for you providing the service? Oh, look, I think in terms of delivering services to individuals at home, it would be better if it was the individual with an organisation directly. That's without a doubt it cuts away or the bureaucracy from a national level. However, that can play other problems as well. But I do believe that that works in many cases

because people develop a relationship with the service and the service knows what they're dealing with as opposed to sometimes services aren't sure what they're dealing with. There's all admin fees that get disappeared, management fees get taken up. And that happens right across all of those different services from NDIS to my age care services. And it's such a waste, such a waste of taxpayers' money. Yeah. I think that's probably one of the downfalls of having to go through that national.

process. I can see how it is important to be assessed, possibly on the national level, and in terms of a person's needs, absolutely. So if people are moving from state to state or territory, that they can have at least the level of assessment right across Australia, but I still believe that needs to be a local service link up to the individual. That's the way I, I, I'm foresee it, but who knows, time will tell, maybe we'll go to that model down the track. No, that makes so much sense. It's always interesting to me talking to someone who wasn't a social worker when the old system was around.

So people are going through university, learning about social work, learning about these new services, as though that's how it's always been. And sometimes I find myself just reminding people that in many ways it is better, in many ways it has brought people closer to self-management to some degree or it's brought someone a quicker assessment process. I can think of an example where I had someone who was under 65 had a stroke and waited nine months in a residential care facility for addict to do an initial assessment. So that's just to be able to have any sort of support at home, whereas now at least there are systems in place. Yes, it's adding an extra level of complexity or bureaucracy sometimes.

But at least in my experience, that extra level is someone who has similar experience and training to us who can help be sort of like a safeguard or a gatekeeper to some degree who can say, well, yes, this person is a priority. So I will help advocate up the chain. So yeah, it's interesting to see how over time there have been these different priorities in policy and funding and yes, there are positives and negatives to everything. And I think our job is really just to understand those systems so that we can do our best work within them. Yeah, absolutely. Are there any other areas of social work that you're passionate about or would like to work in? You mentioned you do a lot of education and helping people to realize their potential,

but also that international work, community development, if time and money were no issue, what would you be doing? I'd love to go overseas and do a stint overseas. Now that I've got older family members of my own children, I would really like to give it an opportunity. And who knows where that would take me? I mean, even if it was 12 months that I did something like that, I think it would be brilliant to do it overseas.

Other areas that I've always been interested in have certainly been hoarding and squalor. I guess that's an area that I've always been interested in. And maybe that could be something I could look more into down the track. So I think I'm yet to get in more and bite my teeth into those areas. Yeah. Are there any particular programs or projects that you're working on at the moment? At the moment, I'm not. I did start a project, but I'd be very keen. I'm waiting for another practitioner to come on board to work on engaging with. It's called a leg club, but basically it's about patients coming on board and using each other as tools of information and also engagement for one another. So it's got, I guess, that a bit of

to empower each other, but also the ability to provide connection within the community. So it's very typical of that social work community group work mentality, but it's taking people who are extremely dependent on services and not having those services in place increases their isolation. So it's how do we empower those individuals to continue to be connected with the community. And is that sort of like a mentorship program where someone who has overcome a lot of similar issues

can be paired with someone who's going through them? Well, it's not a mentoring component to it. It's probably more, so it is a group, but it's a group where they, can call the shot if that's the case. But there's no mentor as such. It's really an evolving group which hasn't been trialled before as far as we could see. But I'm waiting for the specialist staff to come back and then possibly work on it from there. Yeah. Okay. Which is always going to be challenging if you're the sole social worker in a program is how do I prioritize this above my caseload?

Exactly. Exactly. Exactly. But eventually once it's up and running, it could be very much self-managed. Like people in the group could be helping to run, to facilitate, to organise, ideally. Yeah, that's right. That's exactly right. So that would be the idea that it runs itself. Incredible. Are there any resources or reading, viewing, anything that other people can check out

if they want to know a bit more about the type of work you're doing? I guess for me it's looking at that holistic perspective of individuals and looking at how different systems come together to encompass and make the person that I'm dealing with and the situation that's in front of me. So really my perspective and where I've come from has always been that systems theory base and looking at solutions focused. So in terms of looking at different materials, I guess I have gone back, believe it or not, to my theories back at uni, which I know are fundamental and still have a place in today's society, even with all these changes that we've gone through with COVID and internationally, how we have really changed our view of the world. I still go back to those theories because at the end of the day for me they speak about what social work is and that essence of advocacy looking at self-determination, looking at information, chances, opportunities and choices for you. So my ethos has always been around that self-determination and looking at how others influence you. Yeah.

No, that definitely comes through. I can see really how your priority has been supporting people to be heard and to have quality of life, however that looks. And what you're seeing is similar themes across the board. I guess you're discussing with your networks. You're getting a sense of what other people are finding difficult and trying to come together and come up with solutions. But I also think the positive work you're doing,

is really affecting the way health systems are perceived because you have that opportunity to, if someone's had a negative experience with something, they're going to carry that through, whereas you're trying to provide opportunities and time and space for someone to really sit with what's happening to them at that moment and to help overcome that in a really empowering way. But what you said before about, there's more to the person than is what's written in their medical history. So really having that opportunity to get to know someone which you've got more time to do in the community, which is wonderful, and to help demonstrate that to the other people that you work with so that they see that person as such an individual. Is there a degree to which

your work is focusing on reducing readmission rates as well? I would imagine that would be a priority for someone who's come out of hospital who people are testing the waters to see if they struggle. Yeah, there are different teams in different areas of Sydney that do have hospital avoidance team and certainly we try to get them involved if we feel that there's that grey area of really they could stay at home but we just need this doctor, this allied health profession to come in and just assess the situation to be sure. And most often they've been great. They've been terrific.

It's really good to have that on board. There have been times, though, where people have been so unwell and the community nurses have essentially called and organised for admission to hospital. So I think that those situations certainly have been warranted. But we do have a great service as well

that actually does. avoid hospitalisation, but in the same token, if they need hospitalisation, then they're great to have on your side to say, yes, we've checked it out and they cannot be looked after at home. They need to go to hospital. Yeah. Sure. Yeah. And for some people, that is the least traumatic option.

Absolutely. As opposed to, yeah, some people would see hospital as traumatising. But for some people, being in the comfort of that environment where there's structure, there's food provided that they might not have at home. There's that support there. Yeah, absolutely. I love that every day is different as well with your job. Like you never know what you're going to see from one day to the next.

And that can be incredibly thrilling. Some people might find that very daunting and find that that's a little bit too much for them that they need predictability. But I'm very similar. I need a little bit of diversity and I need the thrill of having to work quickly and think quickly and come up with plans on the fly. I think it's incredibly important work and I think it takes, yeah, a special sort of someone to be willing to do that and especially working by yourself.

It's always going to be challenging. Absolutely. Yeah. Thank you so much, Kathy, for meeting with me. I think it's incredible work you're doing and I really look forward to seeing where it takes you. I hope you get to do some of these other exciting options, including the overseas work. and all this training and these programs that you've got some great ideas for

you're doing amazing work on the ground. So keep it up. Thank you, Yesman. I really appreciate your time. And I hope someone takes it further as well. Thank you again. Thanks for joining me this week. If you'd like to continue this discussion or ask anything of either myself or Kathy, please visit my anchor page at anchor.fm slash social work spotlight. You can find me on Facebook, Instagram and Twitter, or you can email SW Spotlight Podcast at gmail.com.

I'd love to hear from you. Please also let me know if there is a particular topic you'd like discussed, or if you or another person you know would like to be featured on the show. Next episode's guest is Peggy, who has worked in New South Wales Health for over 27 years in a variety of social work and health manager roles. She is currently working for Queensland Health as a social worker in the Queensland Pelvic Mesh Service. She is passionate about supporting and developing social workers and encouraging them to look outside traditional social work roles for job opportunities.

I release a new episode every two weeks. Please subscribe to my podcast so you're notified when this next episode is available. See you next time.