Tag Archives: enhancing health and wellbeing in dementia

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Enhancing health and wellbeing in dementia. Book launch in the Arlington Centre, Camden.

When all is said and done, I am not a big fan of the social care and NHS services being run down, with the reassurance that if you did deep into your pockets and promote a certain type of research into dementia there might possibly be a cure for dementia by 2025.

I’d like to thank @MrTopple, Steve Topple, for this outstanding article in “the Canary” explaining my motivation behind writing a trilogy of books on dementia.

The third, and final book, I felt built on my two previous books on dementia in providing an overview of what the overall care pathway might look like. The book was published by Jessica Kingsley Publishers on 19 January 2017, and is entitled “Enhancing health and wellbeing in dementia: a person-centred integrated care approach.”

Thanks enormously to my publishers, Jessica Kingsley Publishers, for great support in providing a selection of dementia books including mine for the afternoon.

The book follows the following ‘planks’.

Six themes

Thanks very much to the Arlington Centre, Camden, for hosting this third book launch. I was pleased we had a great mix of around fifty people there, including Prof Dawn Brooker who has written extensively on person-centred care in dementia.

Kate Swaffer led the discussion at the end of the programme of talks, in response to the topics covered.

Photos of the event

failure in person centred care

haha

Lisa and Dig Dog

ripal 2

Nicky Ripaljeet

Gina2

Gina 1

Jo

wellbeing

Yvonne and Jo

Another Reinhard

Lisa Kate and Marian

what goes look like

Lucy cost 0

Sarah

Kate and Lisa

Kate

Reinhard and Hilary

Angela and Hazel

M S robot

shibley signing

Disc

Reinhard

Terrific afternoon

andy tysoe

shirley

some books

group

hilary alan jo

maneesh

more books

andy and ripaljeet

andy rebecca

rebecca

ripaljeet

ripaljeet andy

suzie and kate

Presentations

Enhancing health and wellbeing in dementia

Enhancing health and wellbeing in dementia from Shibley Rahman on Vimeo.

Discussion extract (chaired by Kate Swaffer)

Promoting wellbeing in care homes: Yvonne Manson and Joe Walker, Balhouise Care

Preventing excess disability in dementia through psychological therapies, Reinhard Guss

Living alone with dementia, Jo Moriarty

Person-centred care in acute hospitals: a clinical specialist nurse’s view. Lucy Frost

Supporting well in dementia care in the future, talk by Maneesh Juneja

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My final book on dementia: on a person-centred approach to enhancing health and wellbeing

The title of the book reflects the fact every person has a human right to health, and that wellbeing is a critical part of wellbeing. It was published earlier this month by Jessica Kingsley Publishers (page including pre-publication reviews here).

 

Many of the issues raised in the book coincidentally have been raised in the draft World Health Organization global ‘draft action plan’, worth a look at here http://apps.who.int/gb/ebwha/pdf_files/EB140/B140_28-en.pdf, published 23 December 2016.  It is felt that while this document is not ‘perfect’ it is a good start. For example, the palliative care approach is specifically signposted in clause (56).

 

People are entitled to the best of care regardless of setting – for example, Dementia Care Mapping™ (DCM™) has been used as an observational tool which has been designed to be used within formal care settings such as care homes, nursing homes, day services and hospitals. This book is, in fact, in part dedicated to Dawn Brooker, and frequent references are made in the text to Tom Kitwood. The book is also dedicated to Martin Rossor, national director for dementia research, for whom I worked in 2003. I do not of course wish to speak about the specialist area of personhood as I feel that would be entirely inappropriate.  An excellent book on this area, however, is “Person-Centred Dementia Care, Second Edition: Making Services Better with the VIPS Framework”, by Dawn Brooker and Isabelle Latham, also published by Jessica Kingsley Publishers https://www.amazon.co.uk/d/Books/Person-Centred-Dementia-Care-Second-Framework/1849056668.

 

 

My book is intensely evidence-based but not in a way, I hope, which is off-putting to the primary audience – who are not commissioners, but persons living with dementia and carers. I certainly believe that it is the primary duty of researchers at least to think about the basic translation of research into practice. Many of the interventions and service developments will ultimately rely on this.

 

Thankfully, there are people in care settings who think very carefully about the environment of care, for example helping carers identify, find solutions and create a care culture to overcome mealtime eating problems in dementia. ‘Working with’ collaboratively not working to patients has been a fundamental change in attitude for organising services and research, and the fundamentals of co-production are intimately linked to citizenship and human rights. And we do need to ensure people get access to the right care at the right time. For example, there can be difficulty seeing your GP, or dementia care is an increasingly important strategic consideration for palliative and end of life care providers, including hospices. It is noteworthy that, through working in partnership with their local community and care providers, hospices can ensure that the best of hospice care is extended to everyone affected by a diagnosis of dementia within their local community.

 

 

Responding to the challenge

 

The NHS Five Year Forward View, the current strategic ‘masterplan’ of the NHS, emphasises integration, personalisation and empowerment:

 

There is broad consensus on what the future needs to be. It is a future that empowers patients to take much more control over their own care and treatment. It is a future that dissolves the classic divide, set almost in stone since 1948, between family doctors and hospitals, between physical and mental health, between health and social care, between prevention and treatment.”

 

Chapter 1, Five Year Forward View, 2014 (https://www.england.nhs.uk/ourwork/futurenhs/nhs-five-year-forward-view-web-version/5yfv-ch1/)

 

Dementia has been the target of much stigma from society, and despite the rhetoric of ‘parity of esteem’, much more can be done to understand the physical and mental health needs of persons living with dementia.  Recent initiatives such as ‘dementia friendly communities’ have identified that dementia is unlikely to be the only medical condition a person might live with long-term, and all that communities should be inclusive and accessible. Preventing certain people from being lonely and isolated has immeasurable social and well-being benefits for the individual. There are some amazing ‘dementia friendly’ initiatives – for example, a visit to the theatre can have a profound impact on people living with dementia and their families. It is crucial that all initiatives are culturally inclusive too, including raising awareness and promoting understanding of dementia within culturally diverse communities, which might mean physically visiting day centres, community groups and religious centres to talk about dementia and tackling the stigma that surrounds dementia.

 

Dementia is thought to be the most feared condition in adulthood, and this can affect diagnosis-seeking behaviours as well as the message that ‘nothing can be done’ after a diagnosis. A person never receives a diagnosis of dementia alone; so, understanding how the diagnosis impacts on that person and those closest to him or her is of fundamental importance. What happens after a diagnosis can be incredibly complex, and we need health and social care systems which are flexible, adaptable, and correctly resourced to cope. Interventions for living well, supporting well or caring well are not just medical, but can also be psychological (cognitive or behavioural) – and might prevent further decline. Professionals can unfortunately instil a feeling of helplessness in a person diagnosed with dementia, referred to within Kate Swaffer’s construct of ‘prescribed disengagement’™.

 

I propose in the book that there are key demands of integrated care which I picture in the Preface as spokes of an umbrella.

umbrella

 

‘Responding’ to a new diagnosis of dementia needs new, flexible ways of adapting.

 

Take for example the description of Wendy Mitchell – living with dementia:

 

However, I’m also hoping I can convey that, although we’ve been diagnosed, people like me still have a substantial contribution to make; we still have a sense of humour; we still have feelings. I’m hoping to show the reality of trying to cope on a day-to-day basis with the ever-changing environment that dementia throws at those diagnosed with the condition. Living well with dementia is all about adapting. Adapting to new ways to enable us to live better for longer with dementia.”

 

(Wendy Mitchell’s blog – “Which me am I today?” https://whichmeamitoday.wordpress.com)

 

Dementia is a prevalent condition, but trends are complicated due to the effect of risk reduction work, the numbers of our ageing population and improved rates of diagnosis nationally. There are approximately about 900,000 people currently living in the UK with dementia. However, the nature of the condition means that managing it can pose unique and sometimes difficult issues, both in the community and in other care settings, and “dementia is everybody’s business” meaning that this is a widespread societal concern, not just the caring professions.

 

With the right support and opportunities, people with dementia and carers can successfully communicate, engage, participate and continue to be part of relationships and communities, and this is no matter how advanced their dementia.

 

This third book provides some of the ingredients to a recipe providing the change for people living with dementia and carers would be supported in a holistic, person-centred way. It is impossible to deliver person-centred care in an exceptional way, without staff feeling properly supported and empowered to fulfil their roles. The language we use is a critical aspect to this. Notwithstanding, there is a strong sense of interconnectedness in the ‘dementia’ sphere, and people in person-centred integrated care tend to be aligned to certain values of openness, trust, valuing difference, innovation and collaboration.

 

There have been enormous strides in how people living with dementia are supported, however there is always more to be done. Technology now embraces telehealth, telecare, mobile health, telemedicine, e-health, smart home technologies and Internet of Things, but is increasingly including informatics (including electronic health and care records), big data, artificial intelligence as well as health and care robotics. Digital technology and social networks provide some of the most powerful tools available today for building a sense of belonging, support and sharing among groups of people with similar interests and concerns.

 

Despite the lack of ‘caring well’ in the NHS Transformation Network, presumably subsumed under ‘living well’ and ‘supporting well’, my book is worth reading with their construct in mind. It can be viewed on this hyperlink: https://www.england.nhs.uk/mentalhealth/wp-content/uploads/sites/29/2016/03/dementia-well-pathway.pdf.

 

dementia-well-pathway

 

Cost pressures are requiring providers to find new ways of developing a compassionate, capable and competent, yet affordable workforce. Furthermore, both specialist and generic services can struggle to cope with the increased demand upon services. We know there’s a ‘funding gap’ referred to the ‘Five Year Forward View’. But this should be the driver behind transformation plans. Many people involved in dementia care feel there’s also a ‘time gap’ – people with dementia need more of it and hospitals don’t seem to have any. The experience of someone with dementia is often affected by how well the discharge out of hospital goes. For example, a specialist occupational therapist to make sure we got the discharge process right for dementia patients and focussed on safe transfer of care from hospital into the community. Many would like to give a commitment to really making time for residents in its care homes and houses allows all to be treated as individuals, as this provides an environment where residents who are living with dementia can improve their quality of life.

 

The pressures on residential care are enormous. Some care homes face insolvency. A person with dementia is an individual with individual needs and changes to the environment can affect that person, and these could include the health and wellbeing of staff.  The potential problem with framing promoting wellbeing as ‘activities’ is that the focus instead of being on the person becomes focused on the task. Promoting wellbeing might advance ‘life skills’ and improve mental condition, helping and inspiring participants to reminisce and rediscover aspects of their lives. Ideally then all ‘activities’ would be based on the interests, desires and wishes of our residents, and might include tai chi, massage, cream tea, arts, singing, flower arranging, or music. We know that communication is incredible important. Stories can strengthen emotional links between generations, and help to mitigate against negative effects of the combination of dementia, depression and loneliness in communities.

 

We live in exciting times.

 

 

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Enhancing health and wellbeing in dementia: a person-centred integrated approach, reviews

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This is a book all about a possible integrated care pathway for dementia. It places at the heart of the narrative a person who’s received a diagnosis of dementia and the people who care for him or her, so nobody is left behind.

Thanks to the following for their pre-publication comments for my book to be published on 19 January 2017. I should like to thank all of the people below for considering the whole manuscript before offering the following responses.

The abbreviated comments are also provided on the Amazon UK page for my third book on dementia.

 

‘This important book continues our journey of what it means to see the person beyond their diagnosis of dementia, with a fresh focus on freedom, dignity and human rights. Dr Shibley challenges the idea that nothing can be done to improve dementia care. He brings practical thinking around how we can move towards truly integrated, person-centred ways of working – making a timely and valuable contribution to our collective understanding.’

– Dr Helen Sanderson, author of Person-Centred Thinking with Older People

 

“There can be no doubt that ‘Enhancing Health and Wellbeing in Dementia’ should be essential reading for anyone with an interest in improving the lives, and rights, of people living with dementia. It is an important book which is both comprehensive and practical – no easy matter to achieve! His encyclopaedic span concludes appropriately with the primacy of person-centred approaches, the importance of dignity, quality and leadership – yes, yes, yes!”

– Des Kelly OBE, Chair, The Centre for Policy on Ageing

 

 

“Shibley’s voice has emerged as an important one to take notice of within dementia care. His ability to draw together a huge range of knowledge from many different spheres of research, practice and policy and to use it to light our way rather than confuse us further is unique.”

– Prof Dawn Brooker, Director of the Association for Dementia Studies at the Worcester University, UK

 

“An absolute gem of a book. Through his career, Shibley Raman has been sequentially academic neurologist, service user, family carer and blogging activist. His learning and wisdom have been distilled into a highly readable, comprehensively referenced and bang up-to-date companion for anyone who needs to learn and understand about people with dementia and what can be done to help them, their families and professional carers to get the very best out of life.”

– Prof Robert Howard. Division of Psychiatry, University College London

 

“Practitioners, family carers and people with dementia looking for a comprehensive resource about dementia need look no further. Few books combine detailed explanations about clinical aspects of dementia with policy analysis and yet remain so centred on people’s individual experiences. This is an important resource for anyone who wants to understand more about providing better dementia support.”

– Jo Moriarty, Senior Research Fellow and Deputy Director, SCWRU, King’s College London

 

“The third of Rahman’s books on issues relating to dementia. Another must-read text that discusses the many and varied elements of what is required to enhance the lives and wellbeing of people with dementia. I particularly like his style of telling us what we can expect to learn from each section and suggestions for further reading.  This, as well as the first two books from the author, is an essential read for all health and social care students in gaining an overview of caring in dementia.”

Dr Karen Harrison Dening, Head of Research & Evaluation, Dementia UK

 

“This is a complex and difficult journey and Dr Rahman’s book is like having an informed, interested, intelligent and profoundly humane friend by your side on the journey through. This book is a friend that is encyclopaedic in knowledge and who is not afraid to have opinions and to express them. We are part-way along the journey, we have come a long way but we have far to go. This book helps us reflect on where we are and the road we have travelled, all the better to plan and travel the road ahead.”

Prof Sube Banerjee, Chair of Dementia Studies at Brighton and Sussex Medical School, co-author of the English dementia strategy (2009) “Living well with dementia”

 

“‘Great book on integrated, person-centred dementia care. Clearly identifies issues often overlooked: importance of relationships in delivering good care; pivotal role of care homes in caring for people with dementia; and value of addressing staff needs so they can be in good relationship with others. It’s not rocket science!’”

— Prof Julienne Meyer, CBE, Professor of Nursing: Care for Older People and Executive Director: My Home Life, City University London

 

“This is a wonderful book, for students, health professionals, researchers, policy makers, politicians and families, and for people who may be in the early stages of one of the diseases that causes dementia. This is a book that challenges but also gives hope. Which I think is the greatest gift of all.”

—Lisa Rodrigues, CBE, writer, coach and mental health campaigner, www.LisaSaysThis.com

 

‘Shibley Rahman’s last book in his trilogy on dementia represents a comprehensive and thought provoking tour de force through the subject matter – great reading for any health and social care professional, academic and interested lay person. Here is a perspective from an author who in himself integrates academic qualifications in medicine, law and management with a lived experience of disability. A unique read!’

— Reinhard Guss, Chair, Faculty of the Psychology of Older People, British Psychological Society

 

“What they all have in common is a need for health and social care professionals to come into their lives with understanding, and a recognition of the need for the diseases that cause dementia symptoms to be understood, so that the person or their carer never feels they are being led blindly through our health and social care systems. They don’t need us all to be experts in the scientific constructs of dementia, but they need us to know enough to respond sensitively and with confidence.

A better understanding of what person-centred care is, in the context of dementia, is what will help us to achieve this. I am hopeful that this book will  appeal to specialists and non-specialists alike, and that it will inform and influence professionals who support people living with a dementia.

This book is an important milestone in Dementia Care literature as it provides information to help us answer the difficult questions we face as professionals helping to support people and families. The different types of dementia all have in common that they cause a person to have needs around changing health and wellbeing. The discussion flowing through this book, points to where the answers are to improving how we meet those needs.”

— Lucy Frost

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Much unites us than divides us on integrated care in dementia

One of the many advantages of not being invited to conferences or not having to apply for any funding or grants is that I am able to think about how policy actually gains meaning (or not) for people on the ground. I am not interested in the marketing of ‘patient opinion’, or the goldfishonomics of telling platitudes to power. The fact is that the NHS and social care pressure points do exist; some ‘leaders’ are milking the system for their own careers and effectively fiddling while Rome burns.

For months, I’ve been writing (completely unpaid, of course) a new book to be published by Jessica Kingsley Publishers on 20 January 2017. The book ‘Enhancing health and wellbeing in dementia: a person-centred care approach” does exactly what it says on the tin, and maintains that promoting health and wellbeing should be no.1 irrespective of setting, such as care home, hospice, hospital or at home.

This week, Health Education England published a very important document. The Dementia Generic Service Interventions Competency Framework is intended to support the development of a competent and confident workforce across the West Midlands Region, all disciplines and sectors, in order to provide an effective, quality service to meet the needs of the people with living with dementia, carers and families, in all settings, including those providing acute care or in the community.

It is divided into nine sections/pathway points which include statements of activities, skills and knowledge required to work effectively at each pathway point with the focal point of the framework is the individual. These are described in relation to my work below.

West Midlands Dementia Competency Framework - Sept 2016 FINAL-5

This framework was commissioned and funded by Health Education England – West Midlands as part of a dementia innovation programme hosted by North Staffordshire Combined Healthcare NHS Trust. It was developed in collaboration with Skills for Health, steered by a multi-disciplinary group of professionals from medicine, nursing, dental, education and academia backgrounds working in primary, acute and mental health settings. The group also engaged with colleagues from social care and 3rd sector organisations and most importantly people living with dementia and carers of people living with dementia. Key contributors included Dr Karim Saad (@KarimS3D) – Project team 1 chair, The people living with dementia and carers who have provided expert reference, advice and guidance, and Chris Malvern (@NHSCMalvern) – MHI LETC Workforce Development Specialist.

With increasing opportunities for risk reduction, tackling stigma and discrimination, defining and setting standards of post-diagnostic support, and developing a sustainable approach to dementia inclusive communities, this means that care providers must now expand the skills of their workforce, ensuring that those living with dementia can benefit from a fit for purpose, integrated, evidence-based dynamic dementia pathway. This is of course much easier said than done, and one of the most frustrating things for me has been that – for years – people have said repeatedly that ‘people are lost in the system’, with a massive reluctance to put down the essentials of the ‘care pathway’. There are of course good reasons not to set in stone signposting to services which no longer exist due to swingeing cuts, but it would be helpful for many people with dementia and their closest to have an idea of what to expect.

In 2008, people with dementia in the West Midlands together with their carers and a multidisciplinary group of clinicians recognised that, despite the worrying demographics of dementia in this region and the projected dwindling numbers of carers, there were no overarching, proactive dementia services. Their vision was to develop a West Midlands Integrated Dementia Pathway to enable anyone with a suspected or confirmed diagnosis of dementia to access an integrated, seamless, proactive and high quality locality based service that encompasses all the expertise to meet the needs of the people with dementia and those of their carers. Likewise, earlier this year I wished to write an inclusive book, educating commissioners as well as helping current practitioners and professionals, but which could be read by friends and families of people living with a dementia diagnosis.

I in the end settled on some specific strands

Multimorbidity

Dementia rarely travels alone.

Interoperability

At its most primitive level, this means data can be free flowing between different parts of the system, such as care home, health and social care.

Rights

Rights give you permission to do something or not to have do something. Whether or not you wish to spend time, effort and money discussing whether international instruments put people with dementia within the disability sphere, the vast majority of people with dementia and carers want to know what rights exist which are meaningful to them in their locality – and how to access them and use them.

Health

Irrespective of care setting, a person with dementia always fundamentally has a right to health. This can be enabled or compromised by healthcare systems. Wherever you are, and this includes care homes, there has been acknowledgement of the need to  promote physical health to maintain mobility and independence, and to do this in a way which maximises someone’s dignity and continuity of care (such as through ‘life story’).

Enablement

Like reasonable adjustments for physical disability, enablement conveys the notion that there are ways to help people with dementia with particular difficulties (say in memory) with help to improve quality of life, health and independence. But it is so much more than what happens in the health and social care sectors (important though that is) – appropriate housing can support a safe environment and using assistive technology can help support choices. It’s important that people are actively involved in care pathway options, where necessary, for example moving to a supported housing situation while able to establish new routines, or a move to residential care if deemed desirable. But there are wider issues indeed, for example the importance of enabling individuals to remain in employment, and the importance of employer support to enable people to remain in employment.

Complexity

Dementia is not simple at all. Catering for any needs of persons with dementia and their nearest needs acknowledgement of the complexity of the relationships between different people and organisations, and needs a system which can make sense out of what appears as chaos at first sight. It’s therefore all the more important to  provide specialist supervision and consultation to individuals and teams on how best to support and manage someone with complex health needs, and to provide dementia specific guidance and consultation to individuals and teams where people need complex and non-routine care for physical health.

Care planning

As such, any journey you make requires you to go from A to B, but planning the journey not only involves some idea of where you might be going but also requires you know what you’ll need to travel successfully. interpret and use information from assessments to develop a meaningful care plan. I hope my book will encourage people to see a benefit of carrying out integrated care planning. There’s been over years, with varying degrees of success, a turn around from people being passive recipients of services to people who are actively and organically breathing life into services so that they stay relevant. Care planning is all about creating and managing relationships with other services, individuals and families, and there are clear advantages to forward planning to avoid crisis, e.g. accommodation and health needs. The person-centred integrated care plan to incorporate wellbeing for the carer and family is a therefore a very significant development.

Independence and interdependence

The ideal would be that the person who “takes control” is the person with dementia himself or herself, but suitable tools are needed for this, such as bespoke genomics information, information about care and services, budgets, etc. But the paradox is that it is not possible to do things alone – because of the complexity of the system the principal actors are involved in a system as a whole and are highly dependent on each other. Take for example the promotion of physical and mental health for people with dementia in a care home – ideally a multidisciplinary team might be involved, for example occupational therapist, social worker, falls prevention service, or geriatrician, but we all know sadly the realities of service provision at present. Post-diagnostic support in this prism is therefore an active process, and individuals might be encouraged, for example,  to inform pharmacist, dentist, podiatrist etc. of a timely diagnosis of dementia.

Promotion of wellbeing

Dementia awareness has helped enormously in raising in terms of knowledge skills attitudes for all those working in health and care. The Care Act (s.1(1)) imposes a statutory duty to ‘promote wellbeing’, and a problem with the word ‘activity’ as applied to care homes is that it puts the focus on the task not the person – promoting wellbeing though is a pervasive aspiration that lives across different care settings, and which could be made available across all care settings through social prescribing.

Person-centred approaches

Concentrating on a person does not mean, of course, to the deteriment of not concentrating on friends, family or other important relationships. It’s important now for us to develop services that provide person-centred care, but pivotal to this is workforce planning, right skills, values based recruitment, fostering values based cultures, bringing activities to people.

Some key points from the generic competences framework relevant to my thesis are provided below.

circles

Access to safe, coordinated care

  • the need to ensure that the health and wellbeing needs of the person with dementia are being taken care of during the discharge and transition process
  • awareness of the common causes of dementia, dementia, and that dementia may be expressed in different ways, for example fear of new people or situations
  • provide specialist supervision and consultation to individuals and teams on how best to support and manage someone with complex needs
  • provide specialist consultation to ensure that the maximum effectiveness of the multi-disciplinary team
  • identify when crisis/emergency planning should take place, ensuring people are prepared in advance, before any crisis occurs

Timely accurate diagnosis and treatment planning

  • the importance of a full medical history, laboratory tests, imaging, physical examination, characteristic changes in cognition function and behavior, in diagnosing dementia.
  • provide specialist supervision and consultation on how to identify hard to recognize or rare manifestations of dementia
    assess complex presentations of behaviour and plan a multifactorial response
  • plan treatment for palliative care/ advance care planning with individual concerned and multidisciplinary team
  •  take into account longer term housing options to reduce transitions, including assistive

Enabling Wellbeing, Care, Choices and Preferences

  • the benefits of a healthy diet/ exercise, dancing, theatre, shopping, other hobbies and interests
  • how environmental improvements to services enhance access and delivery of services e.g. pictorial signage, quiet waiting room
    documents that record personal information about and history of a person e.g. All About Me

Therapeutic care

  • how to make people feel safe and secure in an environment
  •  the importance and significance of essential care to maintain fluid intake and nutrition to avoid harm e.g. falls, infections, continence management and skin care to avoid tissue damage
  • the importance and significance of exercise to sustain fitness, balance and mobility
  • assess specific healthcare risk of people with dementia including sensory needs
  • provide specialist advice and consultation to those providing and managing a person with dementia’s end of life care pathway
  • the benefits of cognitive stimulation and meaningful activity
     the range of meaningful and purposeful activities available to meet the spectrum and level of need, memory games and group activities, reminiscence on IPods/MP3 players, magic touch screen, IPad/tablets, painting, string, texture, music, dementia cafes, peer facilitators/leaders
  • the value of peer support e.g. dementia cafe
  • carry out a poly-pharmacy assessment, identifying physical health care issues, e.g. dental problems as a result of some medications
  •  medications optimisation, arrange/carry out regular medication reviews and interaction, this may involve pharmacists, GPs, registrars, nurse matrons, continence teams, advocacy service, district nurses, other prescribers
  •  review previous medication when prescribing new medications

Person-centred Care

  • sexuality, sexual behaviours, loss of inhibitions and sexual health
     where support groups are and how to signpost to these
  • the contribution that can be made by spiritual care/religious and cultural organisations
  • develop organizational policy to enable timley and ease of access to person centered activity and personal budget
  • advise organisation on their strategy for assistive technology
  •  identify areas for future development
  •  contribute to new and innovate technology
  •  plan implementations and strategies
  •  design and deliver user experience evaluations

Family/Carer needs

  • encourage and support the carer in their caring role, including planning respite care
  • give information and education to family and carers about assistive technology
  • how carers passport and mechanisms such as open visiting, involvement pre -operation, assistance with parking, reduce cost of meals can support carers
  • how befriending and neighbourhood schemes help to support carers
  • the importance of enabling carers to remain in employment
    the importance of employer support to enable carers to remain in employment
  • support families, carers and the person with dementia with managing loss and grief.
  • support families using a range of initiatives: dementia surgeries, nurse specialist, Admiral nurses, help lines, crisis management and on line forum

Accommodation and Welfare Support

  • the importance of good, safe, warm accommodation on an individual’s health and wellbeing
  • the importance of sufficient income to meet personal needs and the impact on an individual’s health and wellbeing

Innovation and Improvement

  • utilise research findings to inform practice/share good practice
  • enhancing the knowledge skills and attitudes for key staff (experts) working with people living with dementia designed to support them to play leadership roles

Monitoring and Measurement

  • how to approach and communicate with a person with dementia in order to undertake physical health observations
  • promote lifestyle and behavioural changes that will improve wellbeing
  • knowledge and understanding of dementia care mapping observations, and other tools designed to assess and/or monitor care
  • how and why a positive risk assessment for people at risk of hospital admission should take place
  •  how to minimise risk and take a least restrictive approach

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