Dementia poses unique challenges when the person with Dementia is in an Aged Care facility or is receiving In-Home care. In spite of the many challenges, however, the problems are better understood and advances are being made in the delivery of services to people with Dementia. Alzheimer’s Queensland share some of these in this article.
Auniqueness of dementia is that there is an enormous range of causes and how they impact or present can markedly differ from person to person. Depending on the cause the person’s key issue could be memory or in other cases hallucinations. That said, there are a number of areas that are particularly important.
Managing resistance to care
As the course of dementia progresses, many individuals will require assistance with daily personal care tasks such as bathing, dressing, eating, oral hygiene and toileting. ‘Resistance-to-care’ or ‘refusal for care’ is a commonly reported issue from aged care staff when caring for a person with dementia and it poses a unique challenge. Often the resistance is due to fear and unfamiliarity of the place or person. Strategies to mitigate this challenge include:
• Incorporating services early after diagnosis so the person with dementia can adjust to progressive increases in assistance.
• Appropriately matching aged-care staff with the person with dementia, as best as possible.
For example, an 89 year old man may not feel comfortable getting help showering and dressing from a 21 year old care worker.
• Taking the time to build rapport with the person with dementia and then explaining the task prior to launching. For example, during feeding or meal times the care worker is seated next to the person with dementia, at eye level and engaged in conversation. This is important even if there is no return conversation.
Focusing on skills and interests
In terms of our approach in care scenarios or arrangements in our community centres and residential facilities, in both settings we focus on the skills and interests they have now and what was important to them in their lives before. At all times we encourage inclusion, but respect that some people prefer their own space as well.
Our residential homes are home-like and the multi-service centres are your everyday suburban home. The centre and facilities are set-up to emulate the domestic environment as this is what the person with dementia is able to understand and pick up intuitive cues on how to be and use the spaces.
The physical design in fact is a specific skill area. For instance, intuitively one would think that it is best to remove the rugs in the home with a person with dementia. However, it is very important to consider if there is another way that the situation can be modified. For example, is there a way to stick down the corners to keep the rugs in place, because the rugs themselves could have been an old environmental cue for the person to understand where in the home they are.
At Alzheimer’s Queensland we have Occupational Therapists and an Interior Designer on staff and have staff who have undergone specialist education in Dementia Design principles.
For us, families are part of the deal and we work with them collaboratively, as they wish and are able. Also important to note is people receiving home care are often resistant to having a paid carer in their home as they see it as an invasion of their space. We do see an increased acceptance of care when the person with dementia becomes accustomed to a particular staff member, hence it is important to maintain consistency of staff and avoid a high turnover of the staff.
Ongoing review and adjustment
Bear in mind that dementia is a progressive disease and the person will also undergo changes with the disease progression in their demeanour and their abilities.Understanding the progressive changes, we have a system of continual review of each client/resident’s support or care plan and adjust the intervention or plan to meet our clients’/residents’ and carers’ evolving needs. For our residential facilities we also work closely with specialists and have video-conferencing in place for specialists’ input to minimise the trauma of going for and waiting for appointments.
Another common challenge for people with dementia is poor nutrition and weight loss with people dementia living alone in the community being at high risk. This occurs as the person forgets to eat and also because they find it challenging to execute the steps of the cooking task. Poor nutrition then leads to secondary complications such as confusion, higher fall rates etc.
Nutritional support is highly important for people with dementia. Our observations are that 9 out of 10 people with dementia will have issues with swallowing at some point. This is where the skills and knowledge of a speech pathologist are very important. Across all our facilities, all residents/ admissions are screened by a speech pathologist who develops an appropriate monitoring plan and strategies to support good intake.
Where necessary dieticians are also engaged. All residential staff undergo comprehensive training which includes education on how to recognise difficulties in swallowing and how to support the person with dementia to eat well.
Respect for the person with dementia is central to all our caregiving and we are always finding new ways to improve the service and quality of life for the people we care for.