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Dementia Care: Providing ‘Good’ Dementia Care
Clearly there are a number of elements that are essentials for the provision of good, person centred dementia care. When we refer to ‘good’ we can say that this is care that is systematic, planned, measurable, and reproducible and importantly that can provide evidence of positive outcomes.
From the perspective of someone like myself, who has witnessed the burgeoning of the present day preoccupation with the little understood and less often applied person centeredness, I want to see something more from modern dementia care. I want to see all systems expanded to include the actualisation of a type of relationship based care that shares the choice, power and control between all the stakeholders within the caring relationship.
It is clear that for this triadic relational care to become prevalent we must first of all empower the person living with a dementia. This is where understanding the past few weeks’ worth of blogs is essential. In those blogs I discussed the way the carer can create a positive or toxic culture and that when the culture (the prevailing attitudes and behaviours) becomes the norm how this tips the system towards malignancy.
Now we can start to look at how we shape the culture to be inclusive and empowering to all. Today we look at some of the basics required to begin to empower the person living with dementia so that the core conditions can exist where we can balance out the care environment with equal empowerment of the support systems (family, staff and friends).
Building good dementia care – from the ground up
Good dementia care, should enable people living with dementia to display their emotional reactions in whichever way they choose to (as long as this is not damaging or hurtful to themselves or others) and the quality of care provided should be able to contain and support this emotion. Where expression is damaging to self or others, approaches such as the resolution approaches of Stokes and Goudie and the validation techniques of Naomi Feil (Feil, 1993) are preferable therapeutic approaches as they seek to find the meaning behind these types of behaviours and remove the need for the behaviours by meeting the unmet need rather than by trying to ‘control’ the person (Stokes & Goudie, 1990, 2002; Stokes, 2000). Always remember these are behaviours and not personal characteristics, attempts to ‘control’ the person are baseless and misguided, and we work with the behaviours that are difficult – not difficult people: this preserves our positive view and empowerment of the person.
When staff are trained to provide ‘person- centred’ ‘validating’ and ‘resolution’- based caring many people with dementia will be able to hold on to a positive identity for themselves either by maintaining the appearance of being ‘normal’ in context or by accentuating a part of their lives that fits with an existing way of viewing themselves and their current situations positively. There are those in your care however who need you, the carer, to build or reaffirm this positive identity for them – who they are now will often be reliant on the relational triangle of empowerment as described in figure 1. And how balanced and equal this may be.
Holding on the personhood – the first element
Cheston and Bender (1999) explain that an important part of this process of adjustment and assimilation is provided by reminiscing and storytelling: ‘The telling of stories to an appreciative audience allows people with dementia to make sense of what is happening to them, creates a sense of continuity with the past and creates a shared sense of social being.’
Good caring also adapts this process as a part of the imbuing of ‘personhood’, and life history and life story work should be a universal feature of all modern dementia caring supporting these very processes.
Life history and life story work then is out first ‘brick’ as we build the foundations for our positive approach to providing good dementia care.
In our next blog we will look at life history and life story work in some depth.
Till next time
Paul Smith – Dementia Care Expert