The Challenges of Dementia
In my last blog, I considered the cost to society of caring for our older citizens with cognitive deficits caused by dementia, and also my own shortcomings in caring for individuals in a nursing home setting. In this article I will look at some of the policy and the guidelines for best practice.
Now the SSWA requires that the service-user is fully involved in designing their support package. This can be challenging to articulate for anyone and for many with complex needs, including cognitive impairment, it is a ‘big-ask’. Nowhere is this truer than in the case of an individual with late-stage dementia. I wanted to have a look at care-models which effectively represented person-centred outcomes for older adults so I did a quick-online search.
NICE Guidelines for dementia care services
The National Institute for Clinical Excellence have a quality standard (ref: QS30, April, 2013), in which they outline 10 statements itemising a quality pathway for individuals with dementia. These include:
Appropriately trained staff; timely assessment in memory clinics; availability of information on the condition and available services; a personalised care plan and a care coordinator; attention paid to advanced decision making re: preferred priorities of care; an assessment of carers needs; early assessment of challenging behaviours; good liaison between specialist and primary or general care settings; primary care assessment of palliative care needs; and respite for carers.
So far, there is much focus on service-design, and parameters of care. But what of the need to facilitate well-being outcomes in dementia? How might this be done? A 2015 Welsh Government directive proposes that we become a ‘dementia-friendly’ nation, whilst the SSWA states that one of the determinants of well-being is “I have a social life and can be with the people that I choose…” In the case of dementia this may require advanced decisions and directives re: the care-setting, power of attorney and identification of preferred activities.
One aspect which features throughout the best-practice literature for dementia-care is staff training. Sometimes this will need to relate to the medical condition of dementia itself – signs, symptoms, the disease process and medical management. But this knowledge will always need to be applied in a person-centred way alongside ‘softer’ interventions, which aim at optimising function through maximum engagement in self-care, leisure activities and social settings.
Dementia care model (Kim Warchol)
One commercially available approach, developed by Kim Warchol, is called ‘the dementia care model’ (other models are available!), which seeks to develop the practical caring skills aimed at achieving optimal functioning and quality of life.
The model seeks to have;
- A ‘Proactive and facilitation focus’; so that activities are done ‘with’ rather than ‘for’ and utilises the individual’s best level of ability.
- An ‘Abilities focus’; assessments and interventions focus on remaining abilities which staff can be trained to recognise and tailor care to. This might result in retaining an ability to dress for a longer period rather than having this skill overlooked.
- A ‘Person-centred care’; involves incorporating the individual’s life story into daily care. This is likely to maximise understanding, motivation and engagement as the individual will be focussing on activities of interest and their relevance to them.
I highlight this particular model to illustrate that there are models of practice available which will both facilitate good-practice in the area of dementia care and which are supportive of the goals of the SSWA. However, there are a lot of challenges posed by the well-being concept and in my next article I will explore the difficulty, as we have looked at here specifically in relation to dementia, of eliciting from the service-user exactly what their well-being goals are.
