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Several years ago I was manager of a care home where staff came to me with some concerns. One resident, let's call her Millie, had been in the home for several years and had little family involvement of her own. She saw the staff now as her family, and the staff felt likewise.
Sadly, Millie's dementia had advanced to a stage where hospital admission was being considered. A psycho-geriatrician, after a series of visits to Millie, was advocating a hospital assessment as the best way forward to help. Staff disagreed, and make their feelings known to me. They put the alternative view, that Millie could continue to receive support and assessment in her home while ensuring that in the last stages of her illness she maintained the security of being with familiar faces in the setting of what she saw as her own home. Visiting nurses could advise and assist with specialist support which may have been needed. There were strong feelings among staff that this was the best way forward, avoiding Millie going to unfamiliar surroundings, having increased confusion and ultimately making her condition worse, not better.
I sympathised with the staff and their account of Millie's needs, and at a case conference we were supported by my line manager to go for the domiciliary support which staff saw as in Millie's best interests. Millie lived the rest of her days at home, and I was highly impressed at paid staff adopting the role of a substitute family to ensure that Millie received the best care possible for the rest of her life.
This experience resonated with me recently when I read of the recent publication by Professor June Andrews, director of the Dementia Services Development Centre at Stirling University.
Dementia: The One-Stop Guide
The publication is called Dementia: The One-Stop Guide, and one section gives tips to families and carers of people with dementia on "The dangers of a hospital admission and how to avoid them." Obviously going into the unfamiliar, bustling atmosphere of a hospital from a relatively quiet life at home can have an adverse effect on somebody who is already confused. The book gives many practical tips: help the person to use headphones to distract them with music, visit often and emphasise to staff the special needs of their loved one, and to beware of sedation being used to counter frustration and anger by the person at not being able to communicate their needs effectively.
Lessons to be learnt
Continued support during hospital admissions where these are necessary, and a rapid return to familiar settings, with specialist visiting support at home are the lessons to be learnt. I think there is also a moral that care homes need to be supported to carry out dementia care without unnecessary moves for the person. One ex nurse commented: 'that an acute hospital is no place for dementia sufferers has been known for many years' but said that there is no substitute for close and regular attention to the needs of the individual. I felt privileged to be able to support staff in their quest to do exactly that for Millie many years ago.
Tony Clarke – QCS Expert Scottish Care Contributor