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Dementia Care: Therapeutic Interventions
You can help establish emotional security within the person living with a dementia by keeping the following in mind. I have provided these ideas as list for you – you may wish to print them out – perhaps place them on the staff room walls – these should be thought of as bricks as you continue to lay solid foundations for your person centred approach (More foundations for your care structure)
- See emotional needs as of prime importance.
- Recognise attachment needs and work to meet these at all times – create a plan of care for consistency of approach across the 24 hr. continuum.
- All interventions should be aimed to maximise existing and remaining abilities – you should care plan constantly to achieve this end.
- You should use care planning and risk assessment to compensate for lost abilities and current challenges.
- Your plan of care should show a balance between objectives to work with strengths and objectives to provide safety and dignity, by supporting physical, emotional and social challenges.
- Minimise catastrophising.
- Maximise stability of environment.
- Maximise interpersonal security.
- Minimise stress in the person’s system.
- Minimise random events and extraneous noise.
- Create the social and built environmental conditions to increase the likelihood of all the above.
- Offer long- term support from the beginning of interventions.
- Never leave a resident distressed.
- Facilitate maintenance of loving relationships between relatives and Service User and Service User and staff.
- Explore the possibility of simulated presence therapy, validation, resolution, reminiscence and pre therapy.
- Use Montessori objectives when designing activities and occupations programs.
- Explain reasons and methods of all assessments and practical procedures, etc.
- Set up regular individual counselling – and where required group counselling for families and friends.
- Initiate care only in familiar surroundings (regular environments).
- Where possible take a procedure to the person.
- Person to be helped by a small team of staff with high skill quotient and low staff turnover.
- Optimise communication between person and important others.
- Monitor and minimise stress levels in the environment and in actions between self and important others through carer support and family input and support.
- Control noxious aspects of the environment and provide care in small units or create small care areas within larger ones that provide maximum orientation, continuity and interpersonal security.
- Use signage, colour, lighting, textures and smells to aid the remaining skills of the Service User – do not leave people with short term memory deficits without ‘clues’ so as to find their way around, orientate to their environments and feel secure in understanding the demands of the environments upon them.
- If the environment ‘tells’ the person what’s required of them – they will act appropriately – make sure all rooms make their purpose known.
- The most important aspects of your job remain respect and dignity at all times.
- You must never knowingly place yourself or any other person in a risk situation physically or psychologically.
- You should work in twos wherever this is required and you should allow plenty of time for one- to- one personal interventions.
- Speed is not of the essence, quality is.
In future blogs we will discuss pacing your care around the resident’s time frame and perhaps most importantly stress and the effects of stress on those living with a dementia – on their families, friends and on you the care giver. We will also look at specific therapeutic interventions such a validation and pre therapy. We will look at activities and approaches to activities and occupation and we will spend time looking at adapting environments and the use of signage and care technology
In later blogs we will discuss training and audit and self-audit and the importance of care planning and daily notes – and on your development through supervision, reflection, mentoring and sharing your insights on blogs, at forums and publishing in journals and on line.
Till next time
Paul Smith – Dementia Care Expert
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