Living Well with Dementia

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For when I am in Hospital

B

Your Name

Dear Carer, Please read the information enclosed. It will tell you how I like to be treated; the things I like; how I respond; and how best to support me whilst in Hospital.

Information for when I am in Hospital

Living Well with Dementia

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For when I am in Hospital

Ways of reassuring me (incl. use of special items, name of usual carer etc):

What is important?

I like to be called:

What those who know ……………….

say they like and admire

What relaxes me?

What makes me anxious: signs / body language?

Photograph

Living Well with Dementia

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For when I am in Hospital

How to assist me - Bedtime routine, night time habits, pillows, rails: How I take my medication:

Skills I could quickly lose – if not actively maintained (standing, walking, etc.) –

although I realise success can’t be guaranteed:

How best to support

I am right handed / left handed:

Equipment I need (glasses, hearing aid, stick etc):

Living Well with Dementia

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For when I am in Hospital

IMPORTANT I need support with eating YES NO When I eat, you need to know (swallowing, cutting food, modified diet, thickened fluids etc):

IMPORTANT

Allergies: How I like to take my medication: Signs I am in pain:

Foods I like:

Eating & Drinking

Foods I dislike:

Hot drink I like (milk / sugar?):

Cold drink I like:

I prefer a beaker / cup / mug:

Living Well with Dementia

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For when I am in Hospital

CONTACTS

I need support & guidance with my personal care: YES NO Toilet Shaving

I prefer Bath? Shower?

Name: Tel (Relationship to person)

Name: Tel (Relationship to person)

Personal Care

About Me

I enjoy music / radio/ TV:

My hobbies are:

Parts of my life I like to reminisce about (jobs, interests, etc):

Living Well with Dementia

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For when I am in Hospital

Please note: Although ward staff will endeavour to meet all the documented needs of the patient, this may not always be possible.

Thank You

my life and other resources were inspired by: Person Centred Support Plan by South West Dementia Partnership My PAL work book Rotherham Doncaster and South Humber NHS Trust The Butterfly Scheme – Barbara Hodkinson 2011

my life has been commissioned by:

And developed by:

In partnership with:

North East Lincolnshire

Dementia Forum