Making a Dream Holiday a Reality

We all know that client goals are central to the process of effective, client-centred rehabilitation and are key to the client retaining independence when it comes to what makes them happiest.

Goals can be life-enhancing, joyful, exciting and give a great sense of achievement.  The sense of purpose whilst working toward them is also an excellent motivator for rehabilitation support.

So what do you do when your client tells you “I don’t like goals”?  It’s a dilemma that I suspect more than one case manager has been faced with, and it takes a careful and creative approach to fully support client progression whilst respecting their opinion.

I qualified as a Social Worker in 2001, working for Adult Social Services in a rehabilitation hospital for the first 12 years of my career, spending the last few years specialising in neurological rehabilitation. I was moved into a Community team where I continued to work with clients with a brain injury, but never felt fulfilled or able to achieve the outcomes desired by my clients. I bumped into a former colleague who was working as a Case Manager and she told me about the role and how the focus is on the individual and their goals. I contacted ILS Case Management and started as a Case Manager in 2014.  Ten years later I can say I truly love my work, the flexibility to get creative and support my clients to attain and achieve both their day-to-day goals and their bigger aspirations is a privilege.

Let me tell you a bit about my client Ralf. In 1993 Ralf was studying at university, and living in student accommodation, when he was admitted to hospital for a medication review due to ill health.  During his admission he experienced a hypoxic brain injury which resulted in a medical negligence claim.  He spent two years in a specialist rehabilitation centre before he could then be discharged, to his parent’s address.

I started to work with Ralf in 2017. He lives in his own home with one-to-one support over a 24-hour period.  His injury resulted in some ataxic movements, speech and swallow difficulties as well as some memory problems, issues with orientation and the concept of time. He also experiences sensory overload which affects his ability to problem solve and causes frustration, fatigue and some rigid thinking. He is an extremely intelligent person, he reads several books in one go, usually about complex subjects like Science and Chess and enjoys word puzzles.  He has lots of patience to complete jigsaws, can play the keyboard and enjoys watching programmes on the TV. He has previously visited London, Liverpool (specifically his beloved Anfield, home of Liverpool FC), Scotland and Cornwall, inspired by books he has read or programmes he might have watched.  His last holiday request was born from watching ‘Race Across The World’ and posed a greater challenge – Canada was top of his destination wish list.

I asked his team to sit with him and explore specific ideas about what he wanted to do and or see and how long he would like to visit.  Once we had the ideas and the basic cost agreed, a question was raised by his Mum about the length of the trip as she felt that it would be too long for him to manage.  He had previously only gone away for a week at a time. I undertook a Mental Capacity Assessment and found, on balance, that he did not understand time and/or duration enough and so a Best Interest decision was made by his Lasting Power of Attorney for Health and Welfare that the trip should only be two weeks rather than the three weeks he had requested. I then worked with Ralf to establish which of his chosen activities were most important to him and considered how these could fit into a two-week timetable whilst ensuring rest periods to manage fatigue.

Ralf wanted to travel in Business class, so we asked one support worker to remain with him whilst the other went into Economy to reduce costs.  In Business Class they sat next to each other but because of the privacy screens this made supporting him difficult as the support worker had to walk all the way around so if there is a next time we will plan for aisle seats, next to each other, to facilitate ease of access to support.

A big challenge was an ‘estimate of costs’ for the whole trip, which the Financial Deputy requested.

The actual holiday, flights and planned trips was easily costed and booked by Shona Lyons of Crusader Travel.  I had to find holiday insurance that covered the two support workers and Ralf, as well as the cost of the whole trip in case of cancellation.  I also had to look at how to get from his home to London, hotel accommodation in London for the night before, transfers, cost of meals, any potential additional trips Ralf may want to do once in Canada, taxi costs needed for this purpose and money for tips.  Canada has a ‘tipping’ culture, and it is expected that everyone is tipped for good service from 18% to 22% so it was important this was taken into account!

I had been told about his last foreign holiday before my involvement and I wanted to make sure that I learned from those experiences. Although the previous holiday was enjoyable, during the trip a fire alarm apparently went off in the middle of the night. With Ralf on one floor and staff on another, the evacuation process was a bit fraught!

For this latest holiday, I was also aware that one of the support workers, who was to support Ralf on his trip to Canada, was relatively new so felt I needed to provide reassurance to Mum about her experience and background.  Mum was brilliant and very positive, saying that she trusted me so wasn’t worried at all.  I really wanted to make sure I had considered everything to avoid any complications and make the holiday a real success.

This trip was quite an adventure and really felt like a big step forward in terms of client independence. I needed to balance this with keeping in touch with everything that was going on.

I actually carried my work phone with me for the first 48 hours of the trip, until I had confirmation that they had landed and got to the first hotel, then I relaxed a little.  I had double checked everything that was planned and was confident that once at the hotel all should be good.  I had requested that anonymised contact notes were to be sent daily via email so I could have oversight of each day, get a sense of what Ralf was experiencing and enable me to react quickly if there were any issues.  It was really good to hear that the activities he had requested had been completed and enjoyed and that all was well.

On return I devised a survey to obtain feedback from Ralf about his holiday, his ‘best bits’ and anything he wanted me to know for any future holidays. I also wanted confirmation that the itinerary had worked well and that he had adequate time between planned activities and was able to manage any fatigue. The feedback confirmed his holiday was everything he had wanted and more.  And he’s already talking about where he wants to go next!

Not everything went smoothly. Ralf took his camera but on first use it was found to have a black mark on the lens, spoiling his photos.  The Support workers spoke with him and offered to take photos for him, and air drop them to his iPad.  He thought this was brilliant, seeming to prefer abdicating responsibility for the photos, which meant he could just enjoy the views in the moment. He loved looking through all the photos at the end of each day reminiscing over what he had seen or done.

Unfortunately, the last planned big activity nearly didn’t happen.  They arrived for a pre-booked whale watching trip to be told that only Ralf had been registered as a participant.  The ticket clearly stated ‘three people’ and gave three names but the company disagreed stating only Ralf had a seat and the boat was full.  Ralf and his support workers had a nervous wait to see if anyone was a ‘no show’ which would enable them all to join the excursion.  This trip was high on his priority list, so it was a great relief when they were told they could all board and he was able to see both Orcas and their babies in the wild. An unforgettable sight.

Ralf had an amazing time away and said his favourite part of his holiday was the Rocky Mountaineer, he said it was ‘Brilliant.’  He especially enjoyed the breakfast on board saying it was the best meal of his holiday.

The highlight for me in helping him to achieve this was hearing how things were going each day. I found I was logging into my emails first thing each morning excited to see what they had been doing and what Ralf thought of the experience.  Getting those snippets of feedback made me feel a part of it and I was so relieved and pleased that he was able to do everything that he had wanted to do.  I would get reports from staff that he was repeatedly saying everything is ‘the best.’

Ralf dislikes discussing goals formally.  He likes everything to remain as it is, he dislikes change and when asked will say his goal is for everything to remain the same.  Therefore, I ask that staff encourage him to write on his white board anything that he mentions he might like to do or achieve and I also ensure I receive clear and detailed contact notes from his team so I can informally see what he is thinking and follow up, gently in conversation. This seems to work well for him and gives us the next goal to work towards, without the formality of labelling it.

I would suggest to any Case Managers out there working with a client who longs for a special holiday to start as we always do in Case Management, with your client.  Get their ideas and wishes together, then work to make it happen.  Write lists, work through things methodically, research everything thoroughly and don’t be afraid to use colleagues and professionals to bounce ideas off and to obtain advice.

Then look forward to seeing the photos and hearing the stories on their return.  There is a real sense of job satisfaction in knowing that your client has had ‘the best time’ and that you had a part to play in making that happen for them.  Making a dream holiday into a reality for your client is worth every effort!

Author: Case Manager, Jeanette Morgan

This article was also published on WWW.NRTIMES.CO.UK on 15th July 2024