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Published on: November 14, 2014
by Carolyn Baker for The Guardian:
Whether it’s sticking to routines or working with positive memories, there are ways care workers can really help people with dementia.
Dementia can affect people in different ways, or with different combinations of symptoms. It may affect people’s reasoning, their ability to communicate and their memory so they might have difficulty recognising their friends and family
The wellbeing and quality of life for people with dementia in care homes has been greatly improved on a range of measurable criteria and their requirement for medication significantly reduced through a specialist care programme. Our dementia team at Four Seasons Health Care developed a programme called Pearl (Positively enriching and enhancing resident’s lives), which has been a great success. To help promote better understanding of dementia in care homes I have incorporated our learning into a book. Many of the principles can be adopted by care workers looking after people with dementia in their own homes.
As a starting point, home care workers need to see the person they are caring for rather than the condition, and understand their individuality. Care workers should ask themselves how they would want to receive care – what might upset them and what would happen if it differed from their expectations. Most would want to be cared for by someone who understands something about them and their particular likes and dislikes.
People living with dementia are likely to have a tough time at some point in their journey. As care workers, our job is to try to anticipate that anxiety and work alongside the person to help them feel safe and more confident. What is often labelled as challenging behaviour is most often a distress reaction to an event, situation or feeling and the key is to try to understand the person’s experience and reduce their distress.
The nature of supporting people in their own homes will often (sometimes unavoidably) involve an array of different people providing care. This may be too much for the person with dementia; they may feel confused and anxious about another “strange” face coming into their home. It is so important that home care workers have additional time to form a relationship with their client, prior to carrying out tasks that often involve intimate and personal care.
For someone with dementia, what is happening now may remind them of their past; memories from the distant past become increasingly important as short-term memory is lost. Care workers have to acknowledge this and work with the person within their frame of reference. This can be particularly difficult when the person is asking for someone who died a long time ago, such as their parents. We try to understand why they are seeking their parents; are they frightened or anxious or feeling alone? Validating the person’s feelings can help them talk about their fears, and we can provide reassurance that they are safe in our care.
Life stories and people’s habits and routines are crucial. It helps us to establish the positive memories that we can work with if the person seems troubled. If we know that the person in our care has always woken at five in the morning and sat in their dressing gown until after breakfast, why would we change that? Or, for the man who always shaved every third day, why would we begin to shave him daily?
When caring for someone at home, it is helpful to keep to their routine and to leave the home environment unchanged. This enables them to continue living independently and accessing the things they need. Sticky notes on drawers and cupboards can help them locate things more quickly and reduce their frustration at not being able to find the thing that they were looking for.
If the person being cared for is having difficulty communicating and is not acting as they normally do, physical problems may be a cause. If they push the care worker away while they are helping them with personal care, are they in pain or do they have an underlying infection? If we are helping them to brush their teeth and they push us away, do they need to see the dentist?
No two days are likely to be the same, and the person being cared for may respond in different ways on different days. It is impossible to know what it is truly like to have dementia unless you have it yourself, but we can try and understand some of the frustrations the person may have and support them to overcome these.
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