beth noray, consultancy & training 1 training is only the beginning… extra care housing for...

Beth Noray, Consultancy & TrainingBeth Noray, Consultancy & Training 11

Training is only the Training is only the beginning…beginning…

Extra Care Housing for People with Extra Care Housing for People with DementiaDementia


Thoughts…….Thoughts…….

I want to talk about the importance of training and I want to talk about the importance of training and what it should includewhat it should include

But also to say that it is only the beginning and there But also to say that it is only the beginning and there are other systems and planning that need to be in are other systems and planning that need to be in place to support the training and the person with place to support the training and the person with dementia.dementia.


Staff require trainingStaff require training Supporting people with dementia Supporting people with dementia

requires specific skills. requires specific skills. It is hugely rewarding, but not easy. It is hugely rewarding, but not easy.

Staff need to be equipped with the Staff need to be equipped with the knowledge and skills to do the job knowledge and skills to do the job effectively.effectively.

Training is not just for care staff, it is Training is not just for care staff, it is also needed for housing staff, care also needed for housing staff, care managers and management.managers and management.

Learning is a life long process and Learning is a life long process and people need to be offered training as people need to be offered training as they grow and develop to make use of they grow and develop to make use of their experience and to learn new their experience and to learn new skills and techniquesskills and techniques


What training?What training? Understanding dementia, Understanding dementia,

what it is and to have myths what it is and to have myths debunked.debunked.

The difference between the The difference between the various illnesses that cause various illnesses that cause the symptomsthe symptoms

The major problems it can The major problems it can cause like agnosias, cause like agnosias, dysphasias and dyspraxias.dysphasias and dyspraxias.

The progression of the The progression of the dementing process.dementing process.


Person-centred approachPerson-centred approach What good care looks like for a person with dementia.What good care looks like for a person with dementia. To recognise the person’s strengths as well as needs and work with them.To recognise the person’s strengths as well as needs and work with them. To genuinely promote independence, to maintain existing skills for as long To genuinely promote independence, to maintain existing skills for as long

as possibleas possible To enable and facilitate, collaborate and not to ‘do for’.To enable and facilitate, collaborate and not to ‘do for’. To increase assistance as the dementia becomes more severe, but still not To increase assistance as the dementia becomes more severe, but still not

disempower them.disempower them. To help the person remain connected to the outside world.To help the person remain connected to the outside world. Empower the person, comfort, sustain, validate their emotions, create Empower the person, comfort, sustain, validate their emotions, create

freedom, promotes relationships and confirm identity.freedom, promotes relationships and confirm identity. Understanding the importance of knowing the person’s likes & dislikes, Understanding the importance of knowing the person’s likes & dislikes,

their life history, their preferred lifestyle and routines.their life history, their preferred lifestyle and routines. Understanding how to use your knowledge of the person effectively.Understanding how to use your knowledge of the person effectively.


Increasing well-beingIncreasing well-being Increasing well-being is the most Increasing well-being is the most

important aim of good supportimportant aim of good support Support tailored to meet each Support tailored to meet each

individual’s needs and strengths.individual’s needs and strengths. Behaviour is not set in stone, it Behaviour is not set in stone, it

can be changed just as ours can be can be changed just as ours can be changed by the right approach changed by the right approach and behaviour.and behaviour.

Knowing the importance and use Knowing the importance and use of well-being keys.of well-being keys.

Knowing how and when to divert Knowing how and when to divert effectively and when to go with it.effectively and when to go with it.


Communication skillsCommunication skills To understand the communication To understand the communication

difficulties the person is likely to difficulties the person is likely to experience and the skills to experience and the skills to compensate for them.compensate for them.

Understand the importance of Understand the importance of nonverbal communication.nonverbal communication.

Learn to work effectively with the Learn to work effectively with the person’s reality.person’s reality.

Understand the symbolic Understand the symbolic language a person with dementia language a person with dementia may use.may use.

Develop empathy, self-awareness Develop empathy, self-awareness to hone their skills.to hone their skills.

Understand the importance of and Understand the importance of and develop their interpersonal skillsdevelop their interpersonal skills


Understanding Difficult & Understanding Difficult & Challenging BehaviourChallenging Behaviour

Challenging behaviour is the greatest Challenging behaviour is the greatest cause of moving people on from their cause of moving people on from their homes.homes.

Behaviour is a form of Behaviour is a form of communication, we need to learn to communication, we need to learn to understand what the person is trying understand what the person is trying to tell us by their behaviour.to tell us by their behaviour.

Be able to pick up clues, in their life Be able to pick up clues, in their life history, their lifestyles and possible history, their lifestyles and possible triggers in the environment.triggers in the environment.

To offer support in ways that are To offer support in ways that are acceptable and not upsetting for the acceptable and not upsetting for the person. person.

To understand the importance of To understand the importance of knowing the person and varying the knowing the person and varying the approach to suit their personality and approach to suit their personality and needs.needs.


Physiological: Food, Water, Sleep, Warmth

Safety/security: Security, Freedom from fear, Protection

Belongingness and Love: affiliate with others, be accepted, loved

Esteem: to achieve, be competent, gain

approval and recognition.

Cognitive:to know, to understand, and explore

Aesthetic:symmetry, order, and beauty;

Transcendence

to help others find self-fulfilment

Self Actualisation:to find self-fulfilment and realise

one's potential


Activities and OccupationActivities and Occupation These are not just group activitiesThese are not just group activities An activity can be used An activity can be used

therapeutically to raise well-being therapeutically to raise well-being or to divert at a stressful time of or to divert at a stressful time of dayday

It is understanding that activities It is understanding that activities need to be offered at different need to be offered at different levels of ability.levels of ability.

They should be failure free but They should be failure free but provide a sense of achievementprovide a sense of achievement


Not just the illnessNot just the illness

People tend to put all behaviours down to the People tend to put all behaviours down to the dementia.dementia.

Most behaviours are in fact due to other Most behaviours are in fact due to other factors.factors.


PersonalityPersonality Personality alone can cause Personality alone can cause

challenging behaviours. challenging behaviours. I am going to be a pain. I am a I am going to be a pain. I am a

worrier, perfectionist, control freak, a worrier, perfectionist, control freak, a fighter and very independent. Life is fighter and very independent. Life is going to be very frustrating and huge going to be very frustrating and huge amounts of reassurance and comfort amounts of reassurance and comfort will be needed.will be needed.

My mother could have stayed in My mother could have stayed in sheltered housing much longer, had sheltered housing much longer, had she not resented home care telling her she not resented home care telling her what to eat & when to eat. Her what to eat & when to eat. Her independence caused her to try to do independence caused her to try to do things which were now beyond her things which were now beyond her and was constantly visited by the fire and was constantly visited by the fire brigade.brigade.

We all cope with illness in different We all cope with illness in different ways, even with something as trivial ways, even with something as trivial as a cold.as a cold.


Life HistoryLife History Life is not an easy business and Life is not an easy business and

we all are scarred and uplifted by we all are scarred and uplifted by what happens to us. Events leave what happens to us. Events leave an imprint.an imprint.

Will the trauma of your war Will the trauma of your war experiences or rape return to experiences or rape return to haunt you in your dementia?haunt you in your dementia?

Will the work routines you have Will the work routines you have learnt over the years now become learnt over the years now become challenging behaviours?challenging behaviours?


Physical HealthPhysical Health The person may be in pain The person may be in pain

because they do not know what to because they do not know what to do when this feeling happens, do when this feeling happens, what you call it or forget to tell what you call it or forget to tell someone who can help and may someone who can help and may not remember what a painkiller is.not remember what a painkiller is.

The person’s hearing or sight may The person’s hearing or sight may be impaired but they forget to be impaired but they forget to wear their glasses or hearing aid, wear their glasses or hearing aid, no longer understanding their no longer understanding their relevance.relevance.


Mental HealthMental Health If the person has come into extra If the person has come into extra

care because their life partner has care because their life partner has died, they are going to search for died, they are going to search for them. If they are distressed they them. If they are distressed they are going to search for the are going to search for the emotional support and comfort emotional support and comfort that a partner or parent gave them that a partner or parent gave them and ‘wander’.and ‘wander’.

They may be very confused and They may be very confused and frightened because suddenly they frightened because suddenly they have been transported from their have been transported from their home to this strange unfamiliar home to this strange unfamiliar environment, where often people environment, where often people obviously do not want them.obviously do not want them.

They may be depressed because They may be depressed because life has nothing much to offer life has nothing much to offer them any more. them any more.


Current EnvironmentCurrent Environment It is very important that people do not It is very important that people do not

move into extra care when they are no move into extra care when they are no longer able to make friends or join in any longer able to make friends or join in any social events or become familiar with the social events or become familiar with the environment.environment.

Many residents are very intolerant of Many residents are very intolerant of people with dementia and can make them people with dementia and can make them feel very unwelcome. Some residents are feel very unwelcome. Some residents are subject to abuse and harassment due to subject to abuse and harassment due to their disabilitytheir disability

There tends to be a big difference in well-There tends to be a big difference in well-being between people who have developed being between people who have developed dementia once safety ensconced in the dementia once safety ensconced in the scheme and those who move in with a scheme and those who move in with a dementia and may never be accepted.dementia and may never be accepted.

People who still have their life partner and People who still have their life partner and family and friends who visit are likely to family and friends who visit are likely to be much happier than people who have no be much happier than people who have no one.one.


Cognitive disabilityCognitive disability

This is the degree of This is the degree of damage the person has damage the person has sustained and their stage sustained and their stage in the dementing in the dementing process.process.

The difficulties their The difficulties their particular illness has particular illness has created, e.g. created, e.g. hallucinations.hallucinations.


AssessmentAssessment Experience/training in Experience/training in

interviewing people with interviewing people with dementia.dementia.

What is their diagnosis? What What is their diagnosis? What stage is the person in their stage is the person in their dementia? How disorientated are dementia? How disorientated are they?they?

What can this person What can this person reallyreally do for do for themselves, the need to check this themselves, the need to check this out.out.

The emotional needs of this The emotional needs of this person and the support they will person and the support they will need.need.

The personality, life history, The personality, life history, lifestyle or routine of the person lifestyle or routine of the person and any problems these are likely and any problems these are likely to cause.to cause.


Management systemsManagement systems Support plans need to be integrated with care plans so everyone is clear Support plans need to be integrated with care plans so everyone is clear

what they are trying to achieve and they concur.what they are trying to achieve and they concur. Life histories, likes and dislikes, lifestyle preferences identified and known Life histories, likes and dislikes, lifestyle preferences identified and known

to all staff.to all staff. Emotional needs should be identified and plans devised to improve well-Emotional needs should be identified and plans devised to improve well-

being e.g. overcoming grief or become more assertive.being e.g. overcoming grief or become more assertive. Strengths and skills noted and support and care plans created that enable Strengths and skills noted and support and care plans created that enable

people to use their remaining skills.people to use their remaining skills. Triggers identified and alternative activities created.Triggers identified and alternative activities created. Well-being keys identified for each person.Well-being keys identified for each person. Difficult behaviours and strategies identified and known to all staff.Difficult behaviours and strategies identified and known to all staff. Supporting people with dementia takes time.Supporting people with dementia takes time. Provide information and guidance to other residents about dementia and Provide information and guidance to other residents about dementia and

how they can help.how they can help.


Support for staffSupport for staff

If we are to work in a person-centred If we are to work in a person-centred way, we need to be person-centred way, we need to be person-centred towards all staff, both care and towards all staff, both care and housing.housing.

Staff working with people’s emotions Staff working with people’s emotions need support for themselves, because need support for themselves, because it is not easy, sometimes it’s it is not easy, sometimes it’s disturbing.disturbing.

They need critical incident analysisThey need critical incident analysis An opportunity to talk through issues, An opportunity to talk through issues,

approaches, problems, triumphs.approaches, problems, triumphs. If staff are denied this they will revert If staff are denied this they will revert

to a task orientated or administrative to a task orientated or administrative approach. approach.


RiskRisk

People with dementia do not People with dementia do not understand the risk in doing things understand the risk in doing things they have always done.they have always done.

Assessing the actual risk and seeking Assessing the actual risk and seeking to minimize that risk is much better to minimize that risk is much better than saying no.than saying no.

Life with risks is exciting, being Life with risks is exciting, being wrapped up in cotton wool is boring.wrapped up in cotton wool is boring.

Sharing the potential risk with family, Sharing the potential risk with family, thinking about the quality of the thinking about the quality of the person’s life, not just their physical person’s life, not just their physical safety.safety.


Working with the familyWorking with the family

Families need information about Families need information about dementia and to approach situations dementia and to approach situations appropriately appropriately

They need advice in not buying They need advice in not buying microwave ovens or replacing hob microwave ovens or replacing hob kettles with electric ones.kettles with electric ones.

They are not always right. They are not always right. They know the pre-demented person, They know the pre-demented person,

the professionals know dementia and the professionals know dementia and how the person functions in the how the person functions in the scheme.scheme.

They need to be part of and They need to be part of and understand the support/care plansunderstand the support/care plans

It is important that all staff It is important that all staff understand the grief that families will understand the grief that families will feel. feel.


Severe dementia and deathSevere dementia and death No one wants to die alone, many people No one wants to die alone, many people

with dementia do.with dementia do. You probably would prefer to die at home You probably would prefer to die at home

in familiar surroundings with people you in familiar surroundings with people you know and love.know and love.

Physical comfort and pain reliefPhysical comfort and pain relief Spiritual or emotional support, people may Spiritual or emotional support, people may

well be frightened.well be frightened. Mental stimulation, like music, company.Mental stimulation, like music, company. People will not understand drips, catheters People will not understand drips, catheters

or peg feeds, so invasive assistance should or peg feeds, so invasive assistance should be kept to a minimum.be kept to a minimum.

We need to have a range of peripatetic We need to have a range of peripatetic services who can come to meet the needs services who can come to meet the needs of a person, rather than take them to of a person, rather than take them to another strange and confusing place to another strange and confusing place to receive the care they need.receive the care they need.


People with dementia People with dementia People with dementia are firstly People with dementia are firstly

people like you and me.people like you and me. Training is a block to stand on Training is a block to stand on

and build from, but it cannot and build from, but it cannot stand alone.stand alone.

Extra care can provide the support Extra care can provide the support that people with dementia need that people with dementia need without the institutionalisation of without the institutionalisation of care homes; it can be the ideal care homes; it can be the ideal environment to take someone environment to take someone through the varying stages of through the varying stages of dementia whilst remaining in their dementia whilst remaining in their own home and retaining their own home and retaining their independence for as long as independence for as long as possible.possible.

beth noray, consultancy & training 1 training is only the beginning… extra care housing for...

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