Outcome 1. Understand the concept of diversity and its relevance to working with individuals who have dementia. 1. Explain what is meant by the terms Diversity: This means difference and peoples differences are varied. Race, culture, age, marital status, politics and religion is all what makes us an individual. Anti-discriminatory practice: Action taken to prevent discrimination against people on the grounds of race, class, gender, disability etc. Anti-discriminatory practice promotes equality by introducing anti-discrimination policies in the workplace.
Also known as anti-oppressive practice. 2. Explain why it is important to recognise and respect an individuals heritage. Some individuals may become very withdrawn when they enter a care Home. Being able to do individual things like listen to their favourite piece of music, or having their hair done a certain way, can be very reassuring. Ask family and friends to fill a “memory box” with meaningful items such as photographs, books, items from their family or favourite hobbies which will help them to reminisce. Heritage is the past life history of each individual.
If we learn more about the heritage of a person, we can identify the person’s character, likes and dislikes and habits. It helps us to find out their true identity. 3. Describe why an individual with dementia maybe subjected to discrimination and oppression. The impairment in mental capacity caused by dementia can make people with dementia particularly vulnerable to discrimination and infringements of their rights. For example, they may be excluded from discussions about their care because their views and preferences are not seen to be valid or perceived to be a result of their condition, rather than a legitimate preference.
When this occurs, the person with dementia may also be less able to object, or to challenge decisions that have been made on their behalf. Under the Mental Capacity Act a person must be presumed to be able to make their own decisions “unless all practical steps to help him (or her) to make a decision have been taken without success”. This must become a reality for people with dementia. Ageism – Age discrimination inevitably impacts on people with dementia. The prevalence of dementia increases steadily with age, with the proportion of people with dementia doubling for every five year age group.
Poor support and unjust treatment for older people mean many people with dementia are hit twice as hard. For example, research shows that older people are denied access to the full range of mental health services that are available to younger adults. This particularly disadvantages people with dementia who are often over 65 and in need of mental health support. There are also widespread, mistaken assumptions that dementia is merely “getting old”, rather than a serious disease. This has led to unequal treatment for people with dementia, including poor rates of diagnosis and a lack of appropriate services.
Abuse – Abuse is a serious infringement of the Human Rights Act and has a severe impact on quality of life. People with dementia are particularly vulnerable to abuse. Impaired mental capacity increases the risk of abuse and a person’s dementia can make it harder to detect when abuse is occurring. Abuse can occur across all care settings, including by care workers and professionals in formal; care settings and by unpaid carers, family members, neighbours and strangers in informal care settings.
It can take the form of psychological, financial, emotional, sexual or physical abuse. The Society believes that poor quality care must also be recognised as a form of abuse. 4. Describe how discrimination and oppressive practice can be challenged. As a senior I am accountable for my practice and should always act in the best interests of those in my care. I also have a responsibility to ensure that care which our clients receive is of a consistently high standard whether it is provided by my manager, me or another member of staff.
Therefore I need to challenge others if poor care has arisen and monitor the quality of each clients care experience. It is important to give feedback to anyone on their competence in caring, especially in relation to their behaviour and attitude. If anyone providing care hold negative stereotypical views about our clients and some of these clients are unable to assert their views, or rights or have no advocate this can result in undignified care and at its extreme can lead to neglectful or abusive treatment.
If anyone observes a colleague, another healthcare professional, or family member giving a poor standard of care we intervene as soon as possible, raising our concerns with the individual, while maintaining the safety of the older person. Our approach to the situation should be non-confrontational as very often individuals do not realise that they are behaving in an unacceptable way. If we feel it may be too difficult for us to deal with the issue ourselves we should raise our concerns as soon as possible with a more senior member of staff.
This is particularly important when dealing with a potentially abusive situation with a vulnerable older person. The priority has to be ensuring that the person is safe from harm. It is essential that we follow our organisation’s policies and procedures for safeguarding and protecting vulnerable adults, dealing with discrimination, oppression whistle blowing, as other agencies such as social services or the police may need to be involved. The manager and seniors make sure that all members of staff have the knowledge and understanding of discrimination and oppression. Outcome 2.
Understand each individuals experience of dementia is unique. 1. Explain why it is important to identify an individuals specific and unique needs. The most important reason for gathering this information is to help staff to: •see and understand the person not the dementia •offer person-centred and individual care •give prompts for conversation topics •identify activities and outings which may be of particular interest to the individual •avoid topics or activities that may upset the individual or trigger negative emotions or memories •introduce the individual to other residents who may have similar interests or backgrounds. . Compare the experience of dementia for an individual who has acquired it as an older person with the experience of an individual who has acquired it as a younger person. Dementia is not solely an older people’s condition. In the UK there are over 17,000 people under the age of 65 who have dementia. The assessment, diagnosis and provision of appropriate care and treatment for younger people with dementia, pose particular challenges.
This is partly because their numbers are small and therefore dispersed geographically, but also because their life circumstances are likely to be different to those of older people – they may still be in work, have young families and have mortgages to pay. It is important that younger people with dementia have access to a range of specialised services that address their particular needs and enable them to live well with dementia. This should include not only health and social care services, but also wider services that promote their wellbeing such as financial advice and support to remain in work, if hey choose to do so. It is essential that commissioners of services and service providers recognise the needs of younger people with dementia, as well as older people, and respond appropriately to them. 3. Describe how the experience of an imdividuals dementia may impact on carers A carer is: “Someone who provides unpaid support to a family member, partner, friend or neighbour. This could be because the person is ill, frail, disabled or has mental health or substance misuse problems. ” Therefore, if they are looking after someone with dementia then they are a carer.
However, many carers do not recognise themselves as carers, because they see the support and help that they give as part of their normal relationship with the person they care for. Anybody can become a carer. Becoming a carer can happen suddenly or it might be a gradual process which grows over time. The latter is often the case if they are looking after someone with dementia. They might also find as a carer, that their caring responsibilities may vary over time and may be difficult to predict day to day.
Their caring role may also continue whilst the person being cared for is in hospital or another setting, such as a nursing or residential home. Everybody is different and so everybody who becomes a carer will find the experience to be different. However, many carers find that becoming a carer is an emotional process, which can often happen without preparation. They may feel that they have a lot to learn all of a sudden and that they are not as prepared as they would like to be. Many carers also have times when they may feel resentful about having to care for someone and then feel guilty about these types of feelings.
It is important to remember that they are not the only person feeling like this. Peer support is important and talking to other carers who are going through the same feelings and changes in their lives can be useful. Describe how the experience of dementia may be different for individuals (a) who have a learning disability (b) Who are from different ethnic backgrounds (c) Who are at the end of life (a) Learning disability: Dementia generally affects people with learning disabilities in similar ways to people without a learning disability, but here are some important differences. People with a learning disability are at greater risk of developing dementia at a younger age – particularly those with Down’s syndrome: •often show different symptoms in the early stages of dementia •are less likely to receive a correct or early diagnosis of dementia and may not be able to understand the diagnosis
•may experience a more rapid progression of dementia •may already be in a supported living environment, where they are given help to allow them to live independently •may have already learned different ways to communicate (e. g. ore non-verbal communication if their disability affects speech) •will require specific support to understand the changes they are experiencing, and to access appropriate services after diagnosis and as dementia progresses. (b) Different ethnic background: People from CALD backgrounds face numerous barriers when it comes to accessing services. These include difficulties with language and a lack of knowledge of the service systems. The lack of culturally and linguistically appropriate services and culturally appropriate assessment is a major impediment to the accurate diagnosis and treatment for dementia.
Brain changes associated with dementia present unique challenges to people from non-English speaking backgrounds, often causing them to revert to their primary language and past experiences. Such changes not only have a significant impact on family relationships but also cause difficulties for service provision. Furthermore, there seems to be a lack of understanding of dementia by many people in some CALD communities. (c) End of life: End of life care for people with dementia is complex. The nature of death for someone living with dementia is difficult to predict.
An older person may die with dementia but may equally die from another medical condition, for example cancer or heart disease, or as a result of another illness and dementia. A minor illness can also exacerbate underlying conditions, causing a decline in a person’s condition or death. Optimising end of life care for people with dementia requires a greater understanding of their care needs and experiences of gradual decline and eventual death. Understanding these areas could inform how best to support health and care home staff to provide palliative care.
Recognising the onset of death – One of the challenges faced by practitioners and families is recognising and acknowledging nearness to death for an older person with dementia. Older people often experience a gradual, long-term decline in their condition so clear indicators of when they may be approaching death are difficult to recognise and agree on. A lack of recognition of dementia as a life limiting disease and uncertainty over how changes in a person’s symptoms can indicate closeness to death can contribute to under treatment of symptoms, such as pain, and the use of more aggressive interventions such as artificial feeding.
Problems with communication, common in the later stages of dementia, can also lead to difficulties in identifying the significance or severity of symptom change. What is needed – End of life care and dementia care have become growing areas of prominence in policy (evident in the NHS End of Life Care programme, the recent End of Life Care Strategy and the forthcoming National Dementia Strategy). The End of Life strategy, however, assumes the timely recognition of an end stage for people with dementia and suitability of frameworks that draw on cancer models of care with limited understanding on appropriateness for people with dementia.
The National Dementia Strategy identifies the importance of improving the care people with dementia receive in care homes but fails to identify end of life care as an area for development. Outcome 3. Understand the importance of working in a person centred way and how this links to inclusion. 1. Explain how the current legislation and Government policy supports person centred working. The goal of inclusive care for dementia patients and other elderly individuals is to enable them to remain living within their community for the longest time possible without being brought into assisted living homes.
While there is more than one model for that integrated approach by various providers, the Prime Minister’s challenge on dementia, launched on 26th March 2012, is a programme of work to push further and faster to deliver major improvements in dementia care and research by 2015, building on the achievements of the National Dementia Strategy. 2. Explain how person centred working can ensure that an individuals specific and unique needs are met. The Government is committed to developing a health and social care system that is founded on personalisation, choice and control.
Person centred thinking and planning is a fundamental stepping stone to achieving this goal – and can be applied within and across all public services to reflect the way that older people want to live their lives. It is essential for the way we all think about and work with older people. Care Plans are the primary source of Patient information. Every specialty, PT/OT/Nursing etc. do an evaluation of the individual and create a program of goals for the patient to attain, therapies needed, schedule of goal levels, etc. Each person interacting with the client can refer to the care plan for any information needed.
Done properly, the care plan reflects an individual person and how to best help them fulfil the goals 3. Describe ways of helping an individuals carers or others understand the principles of person centred care. Assessment, care planning and reviewing are key aspects of best practice. Documenting the service received by individuals is vital. The way in which care services are documented will evidence what is occurring for the individual as well as demonstrating whether person-centred care is integral to the service provided. Key indicators of best practice: a full assessment is undertaken prior to a service being provided * evaluation and reassessment is on-going * all relevant documentation used by the organisation demonstrates that * the individual is fully involved * cultural needs are appropriately considered * well-being for the individual is actively promoted * the language used will be acceptable to the person receiving care * care plans are used as communication tools – evaluation is meaningless in the absence of well documented care * a key worker system matches individuals and staff * relatives (and signi?cant others) feel involved and supported
4. Identify practical ways of helping the individual with dementia maintain their identity. The way we dress says a lot about who we are. For most of us, dressing is a very personal and private activity – and one in which we are used to making our own decisions. As dementia progresses people increasingly need more help with dressing. It is important to enable people with dementia to make their own choices for as long as they can and, if they do need assistance, to offer it tactfully and sensitively. This factsheet contains tips for helping a person with dementia to dress and advice on how to make dressing a positive experience for the person.
Helping someone with dementia choose what to wear is an important role. You will be helping them to retain some choice and to express their own identity and personal style, while making sure that they are clean, warm and comfortable. Give the person choice * Wherever possible, ask the person what they would like to put on. Someone with dementia needs the dignity of having choice in what they wear, but too many options can be confusing, so it may be best to make suggestions one at a time. * If the person has lots of clothes, put the things they wear most frequently somewhere accessible.
This will make it easier for the person to choose. Encourage independence * Lay out clothes in the order the person will put them on (starting with underwear and ending with a cardigan or jumper). Remind them sensitively which garment comes next or hand them the next item that they need. * Make sure that items are not inside out and that buttons, zips and fasteners are all undone. * If the person is confused, give instructions in very short steps, such as, ‘Now put your arm through the sleeve’. It may help to use actions to demonstrate these instructions. If mistakes are made – for example, by putting something on the wrong way round – be tactful, or find a way for you both to laugh about it.
* Place labels on drawers where particular items of clothing are kept, or store whole outfits together. If using labels, a combination of pictures and words may be understood better than words alone. Help the person stay comfortable * Make sure the room is warm enough to get dressed in. * Think about privacy – make sure that blinds or curtains are closed and that no one will walk in and disturb the person while they are dressing. Ask if the person would like to go to the toilet before getting dressed. * Try to keep to the person’s preferred routine – for example, they may like to put on all their underwear before putting on anything else. * It can be useful if the person wears several layers of thin clothing rather than one thick layer, as they can then remove a layer if it gets too warm. * Remember that the person may no longer be able to tell you if they are too hot or cold, so keep an eye out for signs of discomfort. Change clothes regularly Sometimes people with dementia are reluctant to undress even when they go to bed, or will refuse to change their clothes.
It’s important to make sure the person changes their clothes every day, and to find ways to do this without upsetting them. Here are a few ways you could persuade them: * remove the dirty clothing and put clean clothing in its place when the person is in the bath or shower * encourage them to change because someone is coming to visit * tell them how much you’d love to see them wearing something new. Go clothes shopping together * If you’re buying clothes for the person with dementia, try to take them with you, so that they can choose the style and the colours they prefer. Shop in places that are familiar to the person and which match their style and preferences. Remember that large, busy shops with lots of choice may feel overwhelming.
* Check the person’s size before buying. They may have lost or gained weight without you realising. * If the person with dementia will need help trying on clothes, bear in mind that shops may not allow men into the ladies’ fitting room (and vice versa). * Look for clothes that are machine washable and need little ironing, as this will save time. Remember that the person with dementia may not recognise new clothes as belonging to them if they have no memory of having bought them, and may not want to wear them. It may be better to buy more of the clothes that the person likes and is familiar with rather than something different. Accept any unusual clothing choices It is important to respect the person’s choice of what to wear. As long as it does no harm, it’s probably better to accept the person dressing in an unusual way, or wearing clothing that is out of place, than to have a confrontation.
If the person is determined to wear a hat in bed, for example, or a heavy coat in summer, try to respect their choice, unless it might cause potential harm. If the person’s clothing choices are causing a problem, you may want to consider putting away inappropriate items so that the person is not tempted to wear them. Making dressing a positive experience Helping a person to look the way they want to look is an important way of maintaining their confidence. Regularly compliment the person on the way they look and encourage them to take pride in their appearance. Allow enough time
If you are helping someone with dementia to dress, allow plenty of time so that neither of you feels rushed. They may take longer to process information than they used to and this will affect their ability to make choices. If you can make dressing an enjoyable activity, the person will feel more relaxed and confident. * Try to use the time to chat about what you are doing and anything else that might be of interest. * If the person resists your efforts to help, try leaving them for a while. They may be more willing to co-operate if you try again a little later.
Other aspects of grooming When the person is dressed, they might like you to help them with their hair. A woman may like to wear make-up, perfume or jewellery, and this is another opportunity for her to have a say in her appearance. If she enjoys having her nails painted, you might like to do this for her. A man may like to use aftershave or a hair product, or to wear braces or cufflinks. It is really important to get to know what the person with dementia usually likes and not to make assumptions about how they would like to look.
Photographs are a good way of remembering how the person likes to wear their hair, make-up or accessories. The person might be used to going to the beauty salon or hairdressers and may want to continue to do this. Some people may prefer to have a hairdresser come to their house. Practical ideas for what to wear People with dementia may have difficulties dressing. It may help to look for clothes that are easy to put on and take off, such as clothes with larger neck openings and front fastenings, or with no fastenings, or to make some adaptations.
If someone is not enjoying wearing something – perhaps because it is physically uncomfortable, they don’t like it or it is new and seems unfamiliar – it may cause them distress and discomfort. * Use Velcro fastenings or poppers rather than buttons. * Shoes with laces may be difficult for someone with dementia to manage. Try well-fitting slip-on shoes or shoes with Velcro fastenings, or replace shoelaces with elastic. * The person shouldn’t wear slippers for more than a few hours, as they may not offer enough support to the feet. * For women, going without a bra may be uncomfortable.
Some women may find it easier to manage a front-opening bra. Try to avoid self-supporting stockings, as they can cause circulation problems. * For men, boxer shorts are usually easier to manage than Y-fronts. * Remember that the way a person with dementia looks will help them to understand what they are doing. For example, if they are dressed for work they may think they need to go to work. If they are dressed in clothing they usually relax in, this will remind them that they are not at work. Similarly, wearing nightwear during the day may make the person think that it is time for bed.