Matt is a middle-aged man who suffered a traumatic brain injury in 2017. Following his injury, Matt had a difficult discharge from hospital, moving into supported accommodation. He would regularly abscond due to being unhappy in his new home environment. However, with an incredible team working with him and engagement in a regular routine including participation in work, Matt’s behaviours gradually settled, and he became more accepting of his life in Sydney.
There had always the plan for Matt to move to Canberra to live in his own home with carer support and to be closer to his family. When the time came to support Matt with this goal, his social worker assisted with an application through ACT Housing to secure accommodation in Canberra.
As Matt’s case manager, initially, for me, the task of facilitating his move to Canberra was daunting. There was a lot to organise and think about to ensure Matt’s move went as smoothly as possible. With Matt now comfortably settled into his new home, I thought I would share a few key steps and processes that have made this move so successful.
The tips below are specific to Matt’s situation, but the basic plan and steps could be useful in any situation when a client is moving locations. I’ve also put together a downloadable 10-point checklist to guide you through the process.
Initial planning (before offer of a property):
- Once we were aware that Matt’s move was imminent (i.e. within the next 8-12 weeks), it was vital to identify a Case Manager in Canberra. Thankfully, the Lifetime Care and Support (LTCS) Coordinator in the ACT facilitated this process and a Case Manager was identified, the whole moving process became a lot smoother as there was a local person with knowledge of services and providers to support Matt.
- Matt requires 24-hour care, so identifying a care provider in Canberra was the next step. We were lucky as Matt’s current care coordinator advised that they would be able to continue providing care in Canberra although they would need to recruit staff. Matt’s guardian agreed to the care provider continuing for consistency. The process of recruiting support workers then took approximately 4-6 weeks from advertising to interviews and selection.
- In conjunction with the team, I proposed to LTCS that Matt visit Canberra for a weekend. This allowed Matt to familiarise himself with the location, meet his new Case Manager, see his family and participate in activities that he would be doing once he moved to Canberra, such as going to Church. Despite the effort in organising this trip, it was a huge success with Matt being very positive about his move.
- Unfortunately, however, in Matt’s case, the offer of a property took slightly longer than expected. In this time Matt’s mood declined, and he became less enamoured with the idea of the move. This was something we needed to be aware of and consider carefully if Matt’s move was to be a success.
Planning (once offer of property)
- In June 2019, I was advised that Matt had been offered a beautiful new unit in Canberra that had been viewed and accepted by his family.
- The move to Canberra was real! It was time to get into action.
- Given Matt’s behaviours following discharge from hospital, as well as his recent negativity about moving to Canberra, both the Psychologist and I felt it was important for Matt to visit Canberra again to see his new home. We also felt it was important that the Psychologist goes with Matt to support him and to complete training for the new care team regarding behaviour support.
- Again, this visit was pivotal in Matt accepting the idea of moving to Canberra. He had seen his new home, was super excited and started making plans about how he was going to set up his new home.
- Other important planning processes at this time were:
- Identifying Canberra-based treating providers e.g. OT, Psychologist, Speech Pathologist and how handover between the Sydney and Canberra-based providers would occur. One of the significant issues in Matt’s situation was the limited number of providers available in Canberra.
- Identifying a GP and local pharmacist. A request for transfer of information from his Sydney-based GP to the Canberra GP was completed.
- It was determined that his treating Psychiatrist would continue to support him from Sydney via Skype. This raised issues regarding his capacity to access the technology required and options including Telehealth through the GP were explored.
- Given Matt’s need for technology to assist with communication, the team determined that he would benefit from having an iPad. With support worker assistance, Matt upgraded his phone plan to include 40 GB of data that he could use to hotspot to his iPad if needed. Matt requires assistance from a support worker with this process.
- Practical issues needed to be organised including sourcing furniture and whitegoods for the new home. Luckily, Matt had assistance from St Vincent de Paul who was able to source most items for the home as well as provide vouchers for local shops to purchase cutlery, plates and utensils. They also assisted in sourcing a new bed! The only item Matt purchased for his new home was a fridge.
- The support worker was instrumental in establishing Matt’s new budget and also set-up a grocery account with the local Woolworths. With this account in place, Matt had a separate grocery budget from his daily living budget.
- Once a date for the move was confirmed, the practical issues of how Matt was going to get to Canberra needed to be worked through.
- The care coordinator arranged two Sydney-based support workers to travel with Matt to Canberra. Those support workers were to stay with Matt, completing buddy shifts with the new care team. It was planned that they would transport Matt and his belongings to Canberra. This was all good in theory but in the end, due to unforeseen circumstances, only one support worker was able to travel with Matt.
- The reality was that Matt’s essential belongings went with him on the day and the rest of his belongings were transported to his new address by a removalist a few days later.
- Matt was supported to prepare meals for three days. He took these meals to Canberra to reduce the need to shop immediately on arrival.
Once all of this was in place, Matt was ready to move!
As case manager, my job was to ensure Matt’s move went well and to involve him in the process as much as possible. I think that with the help of the treating team, his family and the care team, we achieved a great outcome. I have heard that all is going well for Matt and he is loving his new home! There is still a long way to go in terms of establishing new activity routines, locating and engaging Matt in suitable employment and connecting him with community-based activities, but the first stages are complete. All of Matt’s Sydney-based therapists really miss working with him, but I think we can all take heart and be proud knowing that we helped him achieve his goal of living independently!!