Training is only the beginning

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Training is only the beginning

• Extra Care Housing for People with Dementia

2
Thoughts.

• I want to talk about the importance of training
  and what it should include
• But also to say that it is only the beginning and
  there are other systems and planning that need to
  be in place to support the training and the
  person with dementia.

3
Staff require training

• Supporting people with dementia requires specific
  skills.
• It is hugely rewarding, but not easy. Staff need
  to be equipped with the knowledge and skills to
  do the job effectively.
• Training is not just for care staff, it is also
  needed for housing staff, care managers and
  management.
• Learning is a life long process and people need
  to be offered training as they grow and develop
  to make use of their experience and to learn new
  skills and techniques

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What training?

• Understanding dementia, what it is and to have
  myths debunked.
• The difference between the various illnesses that
  cause the symptoms
• The major problems it can cause like agnosias,
  dysphasias and dyspraxias.
• The progression of the dementing process.

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Person-centred approach

• What good care looks like for a person with
  dementia.
• To recognise the persons strengths as well as
  needs and work with them.
• To genuinely promote independence, to maintain
  existing skills for as long as possible
• To enable and facilitate, collaborate and not to
  do for.
• To increase assistance as the dementia becomes
  more severe, but still not disempower them.
• To help the person remain connected to the
  outside world.
• Empower the person, comfort, sustain, validate
  their emotions, create freedom, promotes
  relationships and confirm identity.
• Understanding the importance of knowing the
  persons likes dislikes, their life history,
  their preferred lifestyle and routines.
• Understanding how to use your knowledge of the
  person effectively.

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Increasing well-being

• Increasing well-being is the most important aim
  of good support
• Support tailored to meet each individuals needs
  and strengths.
• Behaviour is not set in stone, it can be changed
  just as ours can be changed by the right approach
  and behaviour.
• Knowing the importance and use of well-being
  keys.
• Knowing how and when to divert effectively and
  when to go with it.

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Communication skills

• To understand the communication difficulties the
  person is likely to experience and the skills to
  compensate for them.
• Understand the importance of nonverbal
  communication.
• Learn to work effectively with the persons
  reality.
• Understand the symbolic language a person with
  dementia may use.
• Develop empathy, self-awareness to hone their
  skills.
• Understand the importance of and develop their
  interpersonal skills

8
Understanding Difficult Challenging Behaviour

• Challenging behaviour is the greatest cause of
  moving people on from their homes.
• Behaviour is a form of communication, we need to
  learn to understand what the person is trying to
  tell us by their behaviour.
• Be able to pick up clues, in their life history,
  their lifestyles and possible triggers in the
  environment.
• To offer support in ways that are acceptable and
  not upsetting for the person.
• To understand the importance of knowing the
  person and varying the approach to suit their
  personality and needs.

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Transcendence to help others find
self-fulfilment
Self Actualisation to find self-fulfilment and
realise one's potential
Aesthetic symmetry, order, and beauty
Cognitive to know, to understand,
and explore
Esteem to achieve, be competent, gain
approval and recognition.
Belongingness and Love affiliate with others,
be accepted, loved
Safety/security Security, Freedom from fear,
Protection
Physiological Food, Water, Sleep, Warmth
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Activities and Occupation

• These are not just group activities
• An activity can be used therapeutically to raise
  well-being or to divert at a stressful time of
  day
• It is understanding that activities need to be
  offered at different levels of ability.
• They should be failure free but provide a sense
  of achievement

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Not just the illness

• People tend to put all behaviours down to the
  dementia.
• Most behaviours are in fact due to other factors.

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Personality

• Personality alone can cause challenging
  behaviours.
• I am going to be a pain. I am a worrier,
  perfectionist, control freak, a fighter and very
  independent. Life is going to be very frustrating
  and huge amounts of reassurance and comfort will
  be needed.
• My mother could have stayed in sheltered housing
  much longer, had she not resented home care
  telling her what to eat when to eat. Her
  independence caused her to try to do things which
  were now beyond her and was constantly visited by
  the fire brigade.
• We all cope with illness in different ways, even
  with something as trivial as a cold.

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Life History

• Life is not an easy business and we all are
  scarred and uplifted by what happens to us.
  Events leave an imprint.
• Will the trauma of your war experiences or rape
  return to haunt you in your dementia?
• Will the work routines you have learnt over the
  years now become challenging behaviours?

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Physical Health

• The person may be in pain because they do not
  know what to do when this feeling happens, what
  you call it or forget to tell someone who can
  help and may not remember what a painkiller is.
• The persons hearing or sight may be impaired but
  they forget to wear their glasses or hearing aid,
  no longer understanding their relevance.

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Mental Health

• If the person has come into extra care because
  their life partner has died, they are going to
  search for them. If they are distressed they are
  going to search for the emotional support and
  comfort that a partner or parent gave them and
  wander.
• They may be very confused and frightened because
  suddenly they have been transported from their
  home to this strange unfamiliar environment,
  where often people obviously do not want them.
• They may be depressed because life has nothing
  much to offer them any more.

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Current Environment

• It is very important that people do not move into
  extra care when they are no longer able to make
  friends or join in any social events or become
  familiar with the environment.
• Many residents are very intolerant of people with
  dementia and can make them feel very unwelcome.
  Some residents are subject to abuse and
  harassment due to their disability
• There tends to be a big difference in well-being
  between people who have developed dementia once
  safety ensconced in the scheme and those who move
  in with a dementia and may never be accepted.
• People who still have their life partner and
  family and friends who visit are likely to be
  much happier than people who have no one.

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Cognitive disability

• This is the degree of damage the person has
  sustained and their stage in the dementing
  process.
• The difficulties their particular illness has
  created, e.g. hallucinations.

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Assessment

• Experience/training in interviewing people with
  dementia.
• What is their diagnosis? What stage is the person
  in their dementia? How disorientated are they?
• What can this person really do for themselves,
  the need to check this out.
• The emotional needs of this person and the
  support they will need.
• The personality, life history, lifestyle or
  routine of the person and any problems these are
  likely to cause.

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Management systems

• Support plans need to be integrated with care
  plans so everyone is clear what they are trying
  to achieve and they concur.
• Life histories, likes and dislikes, lifestyle
  preferences identified and known to all staff.
• Emotional needs should be identified and plans
  devised to improve well-being e.g. overcoming
  grief or become more assertive.
• Strengths and skills noted and support and care
  plans created that enable people to use their
  remaining skills.
• Triggers identified and alternative activities
  created.
• Well-being keys identified for each person.
• Difficult behaviours and strategies identified
  and known to all staff.
• Supporting people with dementia takes time.
• Provide information and guidance to other
  residents about dementia and how they can help.

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Support for staff

• If we are to work in a person-centred way, we
  need to be person-centred towards all staff, both
  care and housing.
• Staff working with peoples emotions need support
  for themselves, because it is not easy, sometimes
  its disturbing.
• They need critical incident analysis
• An opportunity to talk through issues,
  approaches, problems, triumphs.
• If staff are denied this they will revert to a
  task orientated or administrative approach.

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Risk

• People with dementia do not understand the risk
  in doing things they have always done.
• Assessing the actual risk and seeking to minimize
  that risk is much better than saying no.
• Life with risks is exciting, being wrapped up in
  cotton wool is boring.
• Sharing the potential risk with family, thinking
  about the quality of the persons life, not just
  their physical safety.

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Working with the family

• Families need information about dementia and to
  approach situations appropriately
• They need advice in not buying microwave ovens or
  replacing hob kettles with electric ones.
• They are not always right.
• They know the pre-demented person, the
  professionals know dementia and how the person
  functions in the scheme.
• They need to be part of and understand the
  support/care plans
• It is important that all staff understand the
  grief that families will feel.

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Severe dementia and death

• No one wants to die alone, many people with
  dementia do.
• You probably would prefer to die at home in
  familiar surroundings with people you know and
  love.
• Physical comfort and pain relief
• Spiritual or emotional support, people may well
  be frightened.
• Mental stimulation, like music, company.
• People will not understand drips, catheters or
  peg feeds, so invasive assistance should be kept
  to a minimum.
• We need to have a range of peripatetic services
  who can come to meet the needs of a person,
  rather than take them to another strange and
  confusing place to receive the care they need.

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People with dementia

• People with dementia are firstly people like you
  and me.
• Training is a block to stand on and build from,
  but it cannot stand alone.
• Extra care can provide the support that people
  with dementia need without the institutionalisatio
  n of care homes it can be the ideal environment
  to take someone through the varying stages of
  dementia whilst remaining in their own home and
  retaining their independence for as long as
  possible.